"Working as a microbiologist with MSF means you get to see the full picture"

What influenced your decision to work with MSF?  

I first came across MSF when I did a Master’s in Public Health and Tropical Medicine at James Cook University in Townsville. This course was previously run in partnership with MSF, so a lot of the lecturers had experiences of working with MSF which was often discussed throughout the course.  

I had wanted to work in a humanitarian environment for a while, working in a lab in Australia had become a bit monotonous, and it is easy to lose sight of the impact your work is having on patients. At MSF, you work on a much smaller scale. The samples that you’re responsible for are for patients that your doctor colleagues are working with, so you can understand the whole case. Working with MSF means you get to see more of the medical picture and feel more a part of the medical team.  

You’ve just returned from Sierra Leone, tell us about that project.

In Sierra Leone people have limited access to medical care, and the health system is under-resourced, both financially and in terms of skilled human resources. There are very few doctors and lab services regionally, which means that paediatric and maternal healthcare services are basic.  

In the city of Kenema, MSF runs paediatric services including an emergency in-patient department, a therapeutic feeding centre to treat malnutrition, and an intensive care unit. MSF also runs a maternity and neonatal centre to support mothers with complications in pregnancy. The purpose of the lab is to support with blood transfusions by managing the blood bank, which is supplied on an exchange program. This means that if a patient needs blood, their family will donate blood to replace the blood that we provide the patient from the bank.

What did your work in Kenema involve?  

My main objective was to develop the microbiology lab, but during this assignment the lab supervisor was unwell, so my role changed to cover the lab management as well as microbiology.  There are very few microbiology labs in Sierra Leone, so this work is very important in this region. Antibiotics are readily available and easy to purchase on the street, so are commonly used without a prescription, whether they’re good quality or not.

Women often use antibiotics after their monthly cycle to cleanse, so when they give birth a lot of mothers have already had a lot of antibiotics in their life and have developed resistances. This resistance to antibiotics can be passed onto their babies, which can make treating diseases very difficult. When you prescribe a first or second class of antibiotics to a patient, you don’t know if it’s going to work.  

The microbiology lab in Kenema will help us get an understanding of what the antibiotic situation is in this region. Normally medical staff understand the resistance to bacteria in a country, which informs the protocol for antibiotic prescription. But this isn’t the case in Sierra Leone, so we’re working on developing protocols to help treat people more effectively. 

What challenges have you faced on assignment?

One of the main challenges on every project is maintaining a blood bank – avoiding waste but having enough to cater for the emergency surgeries or maternity cases that require multiple units of blood. If the blood bank is down, we work with the health promotion team to do a blood drive.

When I worked in Yemen on my second assignment, the lab received blood cultures (medical laboratory tests used to detect bacteria or fungi in a person's blood) from all the hospitals in the region. The transportation of the blood caused challenges in processing samples. In Australia it’s uncommon to have a transport time over two hours between the hospital and lab, but in Yemen some of the hospitals were over six hours away, and there weren’t deliveries everyday so sometimes we received blood that was 36 hours old. This meant that we had to adjust testing depending on how old the samples were. Here in Australia the testing process is structured and routine, however when working in other contexts you often have to think about how to get the best outcome for patients based on the resources available. 

Do you have a moment that is most memorable on assignment?

During my third assignment, in Sierra Leone, we used sheep to help us diagnose and treat infections. We used their blood to grow bacteria to determine what is making patients sick and test the bacteria against different antibiotics. I have never looked after sheep before and so had no idea what nutrition they needed. 

Thankfully my colleague Dikko was a Fulani man from Nigeria. The Fulani people have been herders for many generations, and his family have managed livestock, so he was able to help find a good caretaker for the sheep. You never know what skills you will need on assignment. I don’t believe that my colleague expected that his sheep-rearing knowledge would be so useful when he was assigned to this project as the project coordinator! 

What advice can you share for other medical scientists considering joining MSF?  

My advice would be to have a good understanding and training in basic haematology, blood films, cross-matching, and biochemistry; it will make it much easier for you to be placed on an MSF project. In regional areas where there are smaller labs, like Port Macquarie, Lismore or Taree in NSW you can train and move between those areas, so regional training in Australia is great to prepare for MSF.  

In Australia we don’t really have any experience in malaria or parasites so there are some training courses you could do in infectious diseases to help you prepare to work in these areas.