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| At home in foreign lands |
28-Jun-2006 |
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From sleeping sickness in
Sudan
to gender taboos in Taliban-controlled
Afghanistan
, one Australian GP has found a career with Medecins sans Frontieres is constantly throwing up challenges.
By Eleanor Limprecht.
DR Cathy Hewison is a wisp of a woman. Wearing a denim jacket over her plaid miniskirt and black tights, she grasps her teacup with both hands to warm them as she sits in a Sydney cafe during a brief visit home.
Her delicate appearance is misleading. Over nine years with Medecins sans Frontieres, the 38-year-old has taken her Australian GP training to the furthest corners of the world, seeing more poverty, illness and war than the average GP sees coughs and colds. While many doctors are overwhelmed after a single six-month mission with MSF, Dr Hewison finds it difficult to imagine herself doing anything else.
It all began with a TV program.
After leaving school, the young Dr Hewison was working in various jobs in Perth — in a bank, at the post office — and contemplating further study when her mother saw a program on MSF and taped it for her, sensing her socially aware daughter would be inspired by it.
“I realised there was another way to be a doctor,” Dr Hewison says with the unmistakably French inflection she has acquired over the past three years in Paris, where she now works in the medical department of MSF. “To work in Africa, to work for access to health, to look at interesting diseases — the reason I did medicine was to do that sort of work.”
After graduation, she did a three-month internship in Kalgoorlie, then sought out general practice work in rural areas and Aboriginal medical services — from Thursday Island to the Kimberleys.
“Working as a GP in Aboriginal communities was the best preparation you could possibly have for working on an MSF mission,” she says. “You need to be able to treat a wide range of diseases, to have some practical skills, some general skills. I think Australian GPs who work in rural areas are extremely qualified because of the general skills they have.”
The experience paid off when she was accepted into MSF in 1997 and sent to Afghanistan, then in the midst of civil war. “It was a violent time,” Dr Hewison says of her stay in the northern town of Taliquan. While the warlords in the north of the country were fighting among themselves, the Taliban was pushing into the area.
MSF goes to great lengths to prepare volunteers before sending them on missions. But all the briefings in the world can’t prepare you for everything.
“We saw a child with a congenital heart defect,” Dr Hewison recalls. “I could hear the heart murmur but there was nothing we could do. There was nowhere to refer the child. It’s the type of disease you see that is so easily fixed in our country.”
At the time, there were no facilities for pathology, radiology or surgery in that part of Afghanistan. “You have to use the skills you learned in medical school, your stethoscope and your listening skills, your practical hands-on skills.”
Dr Hewison was living in a two-room mud hut and, with an Afghan colleague, seeing more than 100 burqa-clad women a day. One had retained products after delivery but was too ashamed to go to hospital, even after she developed an intra-uterine infection.
“She had a small, beautiful baby and a husband,” Dr Hewison remembers. “I kept going to see her, trying to convince her to go to hospital. Finally I started to give her IV antibiotics at the house, but she needed more than that; she needed to have some surgical intervention. But she refused and it was very, very difficult for me because I knew she was going to die. Even her husband was crying and begging her to go to hospital, but she wouldn’t go.
“That was the sort of thing I didn’t ever really get used to.”
Her next mission was to Africa, where she saw patients poisoned by traditional herbal cures, or scarred by spear cuts administered to treat pain. Some, more impressed by Western medicine, demanded coloured rather than white pills, believing they’d be more effective.
In 1999 MSF was setting up a 200-bed hospital to treat HIV patients in Kenya. One-third of the population was HIV-positive but anti-retrovirals were not yet in use.
“It was very, very frustrating at times. Seeing people dying when you knew people should not have been dying, when these drugs were available in Western countries,” Dr Hewison says. “But the introduction of anti-retrovirals took some preparation.”
MSF’s campaign for access to essential medicines has helped bring down the cost of anti-retrovirals in the developing world from about $US10,000 ($A13,500) per patient to less than $200 ($A270), and the hospital Dr Hewison worked at has now introduced the drugs.
After Kenya, Dr Hewison returned to Australia to finish her GP training before heading back to Africa, this time to southern Sudan. Once again, she was thrown into the middle of conflict as medical co-ordinator of two projects — one for sleeping sickness and the other to help people affected by the country’s ongoing civil war. There were nutritional crises and outbreaks of meningitis and measles, but the biggest challenges involved logistics — getting supplies and staff with no roads, no doctors and all the disruptions of war.
After all this, Dr Hewison moved to Paris in search of a little stability. She now works for MSF France managing its tuberculosis and meningitis portfolios, although she still goes to the field every few weeks.
Her tea grows cold as she describes with palpable frustration the challenges of dealing with multi-drug-resistant tuberculosis and the ineffectual drugs that are the mainstays of treatment. “Treatment is super-long —more than two years. Side effects are horrendous, patients take a handful of drugs every day and injections. We’re trying to find new solutions. But the drug pipeline is very slow and we’re not looking at any new drugs for another 10 years.”
Although many people in the developed world believe the disease has been eradicated, the WHO estimates there are at least 50,000 people with multi-drug-resistant TB.
With meningitis, the focus is on the difficulty of accessing vaccines. Millions of doses of vaccines are needed in the meningitis belt that stretches across the African continent from Senegal to Ethiopia. But there is no long-acting vaccine yet against Neisseria meningitidis serogroup A, one of the most common in the area. The Bill and Melinda Gates Foundation is working to develop a conjugate vaccine, but in the meantime no one knows when the next epidemic will hit.
“From experience we can predict that next year or the year after there is going to be a massive epidemic,” Dr Hewison says. “So one of the big challenges is making sure we have enough vaccine to cover until this conjugate vaccine is available, which is quite a few years yet.”
On top of that, there is the diagnostic challenge. Serogroup tests need to be refrigerated, which is almost impossible in some parts of Africa. “So basically treatment, vaccine and diagnostics are the challenge,” Dr Hewison sums up, laughing in frustration.
Humour is a way to cope with situations like these. There is a network of psychologists in Australia available for returned volunteers, but support from colleagues is perhaps more important. Dr Hewison admits, however, that it is easy to be engulfed by your colleagues in an organisation like MSF. “You work very long hours and socialise outside with all your friends you have from MSF and you never have any other perspective on things.” Which is why she is grateful these days for her partner, who is French and not involved with MSF. “It’s a good release for me,” she says.
When five MSF members were murdered in Afghanistan in 2004, causing the organisation to withdraw from the country, it was a time of soul-searching. As was the death in a plane crash of two of her colleagues in Nigeria last December.
“I have thought, maybe it could happen to me. But I’m living my life doing what I want to do, and if something happened my friends and family would know that. The day I’m not happy in my job, the day I’m not willing to take risks, I’ll stop.”
HARD LABOUR
THE skin of a freshly slaughtered sheep was wrapped around the Afghan woman in obstructed labour and coal was smudged on her face.
A collection of sisters, aunts and grandmothers offered Dr Cathy Hewison their opinions. Never having met anybody who didn’t speak their language, they didn’t realise the Australian GP couldn’t understand a word.
To make matters worse, the patient spoke a different language from Dr Hewison’s translator. “The translator was standing over on the other side of the compound with the woman’s husband, because they had to be far away because they were men, and I’d shout a question to my translator, he would ask the man, the man would ask the woman, the woman would answer back, the husband would then translate it for the translator into the language he spoke and then he would translate it for me.”
Eventually, the sheep skin did its work and a healthy baby girl was delivered. Dr Hewison cut the cord and plunged under many layers of clothing to deliver the placenta.
She walked home afterwards under a clear, star-filled sky, accompanied by the faithful sheep given to her by the local community, and told herself it was a good end to a hard day.
MEDECINS SANS FRONTIERES
Medecins Sans Frontieres was formed in 1971 by a group of French doctors returned from working with famine victims in Biafra. Frustrated by the red tape and interference they’d encountered with government-sponsored aid, they formed an independent organisation funded primarily by non-government sources. MSF has the joint objectives of providing medical aid wherever needed, regardless of race, religion or politics, and raising awareness of the plight of people they help. MSF Australia actively recruits doctors with a minimum of two years of practice post-qualification for volunteer positions. Volunteers must be available for a minimum of six months. To find out more, go to www.msf.org.au.
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