Anaesthetist Dr Graham Knottenbelt returns to MSF after 20 years

You’ve come back to MSF after 20 years. What experience has stayed with you most since then?

When I was working with MSF in Sri Lanka in 2002 we had a newborn baby that needed to be intubated and ventilated just after birth. The problem was that there was no continuing care available so we had to transfer the patient 16 hours over of poor roads and across the areas controlled by the two warring parties. What I particularly remember is the coordinated efforts from both sides of the combat, the MSF logistical team and the hospital staff: everybody coming together to do all they could to give this little baby its best chance of surviving.

What motivated you to return to MSF in 2024?

I feel an innate need to be part of a world greater than my myself and being a doctor has put me in a privileged position where I can contribute in person. It was always my intention to re-engage with MSF once my children were older and less dependent.

How did you prepare for this new assignment after such a long break?

In Aweil we primarily managed paediatric and obstetric patient care. Of course anaesthetist training covers both but, usually working in a specialty paediatric hospital, I had not practised obstetric care for 15 years. With this in mind I organised to spend time in an obstetric hospital before I went to Aweil, primarily anaesthetising for caesarean sections and managing obstetric complications like eclampsia and bleeding, to make sure I was able to cope with these safely. 

Other than that I’ve been involved with other humanitarian organisations doing short assignments throughout my break from MSF, so have managed to keep upskilled in working in resource-limited environments.

What were some of the features and challenges of your role in South Sudan?

The security situation in Aweil was reasonably stable while I was there and the MSF project for women and children is well-established. This meant that it was easy to slot in and work effectively right from the start. MSF runs two operating theatres at the same time thanks to having an experienced, locally-hired anaesthetic nurse in the team. During the day we were in the operating room from 8am to 6 pm, mostly doing paediatric surgeries. Once that finished, I was on call for emergencies overnight which meant anything from a reasonably quiet night in bed to being really busy with emergency patients.

The biggest challenge from my side was dealing with the 45°C heat: there are only so many cold showers you can have in a day (or night)! The only air conditioning was in the operating theatre room, so even if you were called out at two o’clock in the morning for an emergency, you really appreciated the luxury of it. 

How has MSF changed over time, from your point of view?

MSF has become quite a large organisation with most of the public now having some awareness of its values and what we do. It has become more diverse and there is an increased number of locally hired staff working with MSF. I think this is a really positive direction because it’s the local staff who maintain the continuity and community within projects.

Is there anything different in the role of an anaesthetist in MSF now compared to 20 years ago?

The role of anaesthetics has always been an important part of peri-operative care, helping take care of patients throughout their surgical journey. What has changed is that developments and technology have made it easier for us to provide high quality and safer management despite being in a challenging environment like South Sudan.

What do you love most about humanitarian work?

For me the best part of humanitarian aid is the human part. Working with staff who are truly committed to patient care and with patients who smile so generously despite everything they are going through is truly humbling. Sharing our stories, laughing about our differences and rejoicing in the commonality of our human mission is what I most enjoy about working outside my usual environment.

MSF is a fantastic organisation to work with. Their values parallel my own and I look forward to continuing regular assignments in the future.