Covid Coordinator at MSF: We must deal with the pandemic as a cross-cutting issue through our missions
As the coronavirus spread in 2020, touching virtually every country in the world, Doctors Without Borders (MSF) adapted or scaled up its ongoing activities and started new activities wherever a pressing need arose. The Czech branch of MSF also launched COVID-19-focused projects at home, offering its experience and know-how from crisis situations around the world. I spoke to Covid Coordinator at Doctors Without Borders and the organization’s former head Pavel Gruber about the new challenges posed by Covid-19.
“2020 was obviously a very difficult year for everybody. The Covid-19 pandemic has a huge impact on our work globally. But in the meantime, we should not forget that the fact that we have this global pandemic does not mean that wars or natural disasters stop. So, we still need to follow the original plans for our work, while approaching the new challenges posed by Covid-19.”
Doctors Without Borders played a key role in helping in the migrant crisis. How much has the situation worsened in the crisis areas and in migrant camps due to the pandemic?
“The reality is that the paths over the Mediterranean Sea remain the deadliest and most dangerous migrant paths in the world. And this has not changed. The conditions in Libya remain so bad that people are aware of the risks they take when they try to cross the Mediterranean, but they are escaping such horrible conditions that they continue to take these risks. And in the meantime, European countries continue to put up obstacles for life-saving organizations such as Doctors Without Borders. So, this year was extremely difficult for us.”
What about conditions in migrant camps?
“Of course, Covid-19 is worsening the situation. The camps are generally an ideal place for an epidemic to spread no matter if you are talking about Covid-19 or other diseases. There is a huge concentration of people and limited medical assistance. So, these are ideal hotspots for the spread of the disease.”
Where are Doctors Without Borders helping now and how are these places selected? Do you respond to calls for help? And for how long do you stay in one place?
“This really differs. You can have emergency operations that last only months. Then there are long-term operations in countries such as the Democratic Republic of Congo where we stay for years. As for where, well, today we are in over 70 countries. So, to list them all would be difficult. Yemen, Congo, which I mentioned, the Central African Republic, and a few others are the hotspots.”
Where are you sending Czech and Slovak doctors?
“We do not have any specific area where we can say that Czech and Slovak doctors go. They go where their profile is needed most and where their experience is matching. This year there was one curiosity, which does not happen too often: there were five Czechs and Slovaks together in Sierra Leone.”
Can they choose where they want to go, or do you send them somewhere?
“Well, they cannot choose, but they can say no. That means we offer them the mission. We say, ‘Your profile is most needed in the project XYZ in country XY’, and the person can say, ‘Yes, I will go’, or for example, ‘No, I would prefer a less dangerous context’. And then we try to look for a less dangerous or different context for the person.”
In view of the travel restrictions due to the Coronavirus pandemic, how difficult is it to get doctors and equipment where you need them?
“Obviously, it is a challenge. It is making all the travel of supplies and personnel more difficult. But we work for emergency organizations. We are used to overcoming these challenges, and we manage somehow.”
Given your experience in helping in crisis situations and dealing with epidemics, you were also called on to help at home. How have you been helping at home in the past year, and in what way was it different from helping abroad?
“Yes, this is a historic moment for the office in Prague because it is the first time that we started any activities in our home country. It was actually connected to the second wave of the Covid-19 pandemic when we were looking into the situation in the country. Doing the needs assessment, we were trying to identify the needs which would match the experience that we can offer. And we identified the situations in the nursing homes. What we tried to bring in was our experience in IPC, which means infection-prevention-control. Because the situation in nursing homes is such that most of the staff there are not medical but social workers. And now they are forced to deal with a situation for which they are not trained and not equipped.”
One of the things your doctors emphasized was the need for teams to be well coordinated. For the doctors and nurses to know each other and function well together. Was that a problem in the pandemic because different countries sent their doctors and nurses to help elsewhere where there was a crisis? Or are Doctors Without Borders trained to jump into the middle of the action, so to speak, and function well?
“As you say, we are used to jumping right in. That is why we have quite strict and standard protocols for most of these situations, and the tools, boxes, and the equipment that we use are standardized. So, if you are sent somewhere and you know that it is a cholera epidemic, it does not matter if it is a cholera epidemic in Haiti or Asia, Africa, or anywhere else. And it does not matter which nationalities are present in your team, you still know what you find in your cholera boxes, and you still know what you need to do.”
What I meant was, here in the Czech Republic, where hospitals suddenly got help from doctors and nurses from other countries or regions who were not trained to work together, was that something you could help with?
“To my knowledge, the assistance of the foreign experts was quite limited, and it was on the level of expertise and knowledge sharing. It is precisely for the reason that you are mentioning. To parachute a foreign medic into a hospital, no matter if it is a Czech or British hospital, is not an easy thing. So, that is why, in the end, the support was limited to the exchange of experience and knowledge.”
What is the hardest part of it? Do some very good doctors find that they cannot handle it psychologically?
“Well, it can happen, but this is something that we try to minimize by our selection process. Because you can imagine that sending somebody across the globe only to find out after a few weeks or a few months that they cannot handle it is firstly expensive because of the travel costs. But it is even more expensive for the team because usually, the team has one orthopaedist, and if the team is missing this profile it is really horrific. So, that is why the most important aspect for us is the motivation of the person, not only the skills but the reason why he/she wants to join us. And we need to know that there is no negative motivation, or we need to uncover any possible risks that would lead to the situation you described in which the person discovers that he cannot handle it and is leaving the mission.”
One of the things that doctors in this country, and generally in the Western world, found hard to come to terms with was having to decide who to help when faced with a lack of ventilators. I suppose that this is something that you have to accept in missions in poverty-stricken and war-ravaged parts of the world. Could you advise doctors here at home how to make such snap decisions and how to live with them?
“This process is called triage, and it is quite standardized. So, of course, as you say it is extremely difficult. Thank god I am not a medical person, so I was never put in this situation. From debriefing my colleagues, I know that it is one of the most difficult situations to face. On the other hand, it is standardized, so you have protocols which you simply follow, and the only criteria that you follow are the medical criteria. And you divide the patients. For example, the mass casualty triage, which you are describing, means the influx of dozens of patients who you need to quickly sort by who needs assistance first, who can wait a little bit, who can wait a bit longer, and those whom no assistance will be able to help. This process of triage is well known by doctors whether in Europe or anywhere else.”
You have now been helping in developed countries with excellent healthcare systems where the health systems often came close to collapse. What kind of advice do you give there?
“That is a difficult question, you need to prepare yourself for these situations. As an emergency organization, if an issue has a good and bad scenario, we try to prepare for the bad one. Because if you prepare for the bad one, you increase the chances that you get through the situation.”
When I have spoken to doctors back from an MSF mission in the past, they always said it took them a few months to recover from the emotional experience of what they saw and lived through there. How long do you think it will it take the world to recover from the pandemic emotionally?
“That’s a tricky question. The impact is different in different parts of the world. Some countries have much better measures than others to cope with the pandemic. Of course, what happened is a huge shock to the world. Maybe I can answer this way, I hope that we can increase our preparedness to deal with infectious diseases and the next pandemic, which can be much worse.”
“Emotionally it is the most difficult for those directly impacted, those who lost their loved ones. To go back to your question about how our colleagues cope when they come back from the missions: we give them different kinds of mental health and peer-to-peer support. So, the people that lost their loved ones during this pandemic should also receive this help if they need it.”
The world is now pinning its hopes on a vaccine. But many people in Europe are distrustful of it. I suppose that this is not something you see in the developing world. How important is a pro-vaccine campaign in your eyes at this point?
“From an MSF perspective, we know vaccination is one of the most effective measures that the health system has. You are probably right that there is some hesitation in society. So, there must be some support from our leaders, and a campaign would probably be very useful to convince the population about the benefits of vaccination. And, if I may, if you ask me about vaccinating, there is also a point B, which is that the vaccine must be made accessible to everybody, not only the richest nations and countries.”
This pandemic is far from over. How do you see MSF helping in the coming year?
“I do not think that much will change, we must deal with the pandemic as a kind of cross-cutting issue through our missions, and I do not think that there will be a major change compared to what we did in the past year.”
What would you like to see in the coming year?
“Definitely more respect and less fighting. Because we know that what causes the most displacement is fighting, not natural disasters. So, less of that but more respect and more understanding that when people escape their homes, they don’t do it because they want a nice TV. It is not an easy decision to leave your home. Usually, the reasons behind why people do it are very severe, and I would hope for more understanding in this area.”