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Médecins Sans Frontières: First In, Last Out

By  Clare Byrne July 1, 2009

Young Canadian volunteers with Médicins Sans Frontières talk about braving some of the world's worst conflict zones to deliver help where it's desperately needed.

MSF nurse Sharon Janzen is this year’s keynote speaker at the Vancouver Go Global Expo, September 18, 2011. Meet Sharon in person and hear more about her inspiring journey. Visit letsgoglobal.ca for more information.

Imagine that a judge walks into a hospital ward, strides over to a gunshot victim, peels back his bandages and starts counting the patient's stitches. Ask him what he's doing and he tells you matter-of-factly that he's calculating what sentence to give the attacker. "There are quite a few stitches," he says, so he's leaning towards five years.

Sounds far-fetched doesn't it? But swap a village elder for the judge, and blood money for the prison sentence and you have a description of the type of justice system that Sharon Janzen has witnessed in rural Somalia.

Janzen is a 28-year-old nurse from British Columbia. She spent six months last year in Somalia working with one of the world's most respected NGOs: Médecins Sans Frontiers, or Doctors Without Borders.

There's not much talk about Somalia in the mass media these days, a fact that's more cause for concern than complacency. The murder of 18 U.S. soldiers by an angry mob in the capital, Mogadishu in 1993 made it a terra non grata for many NGOs and Somalia sort of fell off the international radar. But the country still has huge issues. For starters, Somalia hasn't had a proper central government since President Siad Barre was overthrown in 1991, and nine years of civil war left basic infrastructure in tatters.

"There are no hospitals, no universities, no law and no police," says Janzen. "There are just warlords and clan fighting. And the medical personnel have all left."

This is exactly the type of place you expect to find MSF. The organization looks after the health of people in areas of conflict or disaster where there is little or no medical infrastructure. It prides itself on usually being the first NGO in and last out.

Janzen was one of five international volunteers on a mission to set up a clinic in Somalia's south-central Dinsor province. Two of her co-workers were Kenyan, one was Swiss and the project coordinator was Canadian. Together they worked round the clock to tend to the health needs of a population of 100,000—some of whom travelled on foot for days to receive medical attention.

"In trauma, we would see two or three gunshot wounds a week," says Janzen. "We also saw a number of children who had limbs blasted off by grenades. Altogether, we had about 35 patients in intensive care, and between 50 to 100 people a day as outpatients."

Periodic drought and displacement have had a devastating effect on the general health of Somalis. Malaria, dehydration and diarrhea, she says, are particularly common in the rural heartland. The little team did its best to heal the sick and fortify the healthy, in conditions that would test the steeliest of stomachs.

"We had to get someone to fan off the flies when we were doing sterile procedures [like stitching wounds]," Janzen recalls.

When they weren't swarming around patients' sores, the flies were feasting on the leftovers in the pots brought by families to the clinic to prepare food. Their cooking utensils, she noticed, went unwashed from meal to meal. To forestall epidemics, the team carried out mass immunizations and doled out advice on how to avoid the spread of diseases.

"We had a big focus on basic hygiene," she says. "If nothing else, we wanted everyone to know how to wash their hands and prepare food properly."

Not everyone could be saved however. MSF just doesn't always have the resources. Janzen tells the story of one of the ones who got away—a tetanus patient who required a tracheotomy to survive. The know-how was there—the group's Kenyan doctor had surgical experience—but the oxygen necessary to ventilate the patient during the operation was not. The clinic, she explains, relied on airlifted supplies, but you can't transport oxygen by plane. All they could do was sit by and watch him die.

"You just do what you can," says the Victoria native, who decided as far back as 1994 that she wanted to volunteer with MSF after reading a report on their work during the Rwandan genocide. What attracted her was the possibility of making a hands-on change in situations where others just wring their hands. "It's an extraordinary feeling," she says, "and it eventually becomes addictive."

"It's a bit concerning," she muses, "because you know you can make a difference. You know how much one person can do, particularly with MSF [because their staff is so thinly spread]. So instead of watching the crisis on TV, I can actually go and help. If I did nothing but immunize all day long in Somalia, I'd be saving lives. It's so intense."

Her next mission, in September, takes her to Sudan's troubled Darfur region, where tens of thousands of people have been killed and over a million displaced in a civil war. Thousands of women have also reportedly been raped by government-backed Arab militias. Janzen will be working on the front line with these patients, using the experience she has gained working on the B.C. Children's Hospital sexual assault team.

Her family is worried. They're just getting over her decision to go Somalia. But Janzen assures them MSF is very mindful of the security of its volunteers, especially after five MSF workers were killed in a terrorist attack in Afghanistan on June 2.

They're told, "Even if you have to leave everything behind, all the equipment, the supplies, even the whole mission—if you're in danger, get out. Your security is more important."

Patrick Robitaille was in Chad's capital N'djamena when he heard about the deaths of his colleagues in Afghanistan. The 29-year-old logistician from Montreal was on his third mission with MSF, dealing with refugees who had fled across the border from Darfur. He remembers the effect of the news on his group.

"It was a very hard blow. Our head of mission knew one of the people killed and the feeling was very sad. [Afghanistan] was the first place MSF offered me a placement. In the end someone else went. Everyone at MSF, you know, was thinking it could have been them in that position."

"The first thing we say is, we'd like to speak to the big guy. The big guy is often an underage rebel leader with a big gun."

People who volunteer with MSF can opt out of places they deem too dangerous, like Iraq or Afghanistan. As far as Robitaille is concerned, however, "the crazier it is, the more proud you are of the work you do."

Robitaille is a relative newcomer to the craziness. Before contacting MSF in 2001, he was working with an Internet firm in Montreal, and before that, with a company that organizes conferences. But the passion wasn't there. His real interest lay in international development, and eventually he applied online to MSF. With only rudimentary knowledge of mechanics and electricity, he barely squeaked by on the logistics test, but his event management experience carried him through.

The logistician is the one of the cornerstones of the MSF mission. It's up to him or her to obtain permits for the team, to organize the transport of all their supplies, to hire local guards, drivers and cooks, and, in some cases, administer the budget.

"With the rebels, we promote the fact that we're independent from all international organizations. We're just there to cure, and that includes curing their people, their families and themselves as well."

It's a job that calls for infinite patience and diplomacy, particularly when you have to negotiate with armed rebels for safe passage.

"The first thing we say is, we'd like to speak to the big guy. The big guy is often an underage rebel leader with a big gun. With the rebels, we promote the fact that we're independent from all international organizations. We're just there to cure, and that includes curing their people, their families and themselves as well."

His first mission in Sierra Leone in 2002 involved rehabilitation rather than emergency relief. After a decade of civil war, the country is trying to get back on its feet with the help of NGOs that had been forced to flee to neighbouring Guinea. MSF got services up and running at an abandoned hospital in Kambia, in the northwest of the country, and set up six clinics providing free healthcare.

Robitaille's memories of Sierra Leone are generally happy ones: peace had been restored to the country, people were smiling, the village where the team was housed had a river running through it, and the local economy was growing.

The picture he paints of the Darfur refugee camps in Chad, from which he returned in July, is much grimmer. Hundreds of thousands of Sudanese have fled across the border to escape rampaging Arab militias, many of them malnourished after days wandering in the desert. Water, since mid-July, has been in chronically short supply. In one camp, 26,000 people were depending on five holes in the ground for water for drinking, cooking and cleaning. And the rainy season had arrived, making it difficult for supply trucks to get through. A humanitarian crisis seemed unavoidable, according to Robitaille.

"Malaria is starting, there's also diarrhea and MSF has started emergency preparations for cholera. We're making beds with a hole in the middle and a bucket underneath [for feces]. As far as cholera is concerned, it's not a question of whether, but when," he says worriedly.

MSF also set up mobile clinics near the border, but continuing raids by Arab militias inside Chad made these areas unsafe for giving treatment. The refugees have to be transported back to the camps by truck, an experience that many find traumatic in itself.

"Many of them have never seen white people and they've never been in a truck. The journey makes them sick and disoriented. Others refuse help because they're afraid of being trapped and of not being let back home."

Two weeks after his return to Montreal, Darfur is still uppermost in Robitaille's thoughts. "It takes a while for the mission to fade into the background," he says. And when it does, the question on everybody's lips is: where next?

In Robitaille's case, it's back to school at Montreal's UQAM University for a two-year Masters in International Relations. He's looking forward to leading a more settled existence for a while.

When you volunteer for missions with NGOs, he says, your life gets postponed. Unless volunteering becomes your life—and that's another matter entirely.

Produced with the financial support of the Government of Canada through the Canadian International Development Agency (CIDA).

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