Sunday, June 26, 2016

Everyday Inspirations #4

Today we have the chance to speak to Dr Mo Yin, a senior resident in Infectious Diseases, about the work she did with the World Health Organization in Liberia during the Ebola outbreak. If you are interested in doing overseas aid work, read on to find out about the obstacles she faced and how she stays motivated despite everything.

1) Tell me about your experiences in Liberia  
During the Ebola outbreak, I had the opportunity to work with the World Health Organization (WHO) in Liberia for 1 month, doing policy work on infection control and prevention.

On our first day there, we were woken at 6am for an emergency meeting. A man had escaped an Ebola treatment centre. He was very sick and hence he probably carried a lot of virus. On his way home, he fell off a cab and 2 young men helped him. They later fell sick but not before getting involved in a gang fight where a lot of blood was spilt. The outbreak had just been beginning to settle at this point and we really wanted to contain the area.

Later we visited the surrounding clinics and were surprised to find that despite being 1 year into the outbreak, they still had not implemented proper triaging and quarantining measures. I saw a man who was supposed to be in isolation take a seat amongst a group of women holding their babies.

In Monrovia (capital of Liberia), there is only 1 main road. There are no postal services and no addresses. Only 100 doctors that serve a few million people. An entire hospital of 700 beds may have only 1 doctor!

There were about 70 Non-governmental organizations (NGOs) working on infection control alone and as you can imagine, the situation was chaotic. Comunication and coordination of efforts were difficult despite the best intentions.

This was the kind of setting that we were met with. Our question was how could we unite everyone’s effort?

With guidance from my supervisors, I came up with an electronic database. We used a very simple online platform- google sheets. The idea being that every time an infection control specialist visited a clinic, they had to have their data entered into these sheets. This allowed us to compare the different areas such that we could easily spot and immediately target what they were lacking eg. personal protective equipment or better training. We could also keep track of how the different clinics were progressing and published this data to the NGOs to make sure they didn’t end up doing double work. All in all, it helped us decide how to allocate limited resources and directed the NGOs where help was needed.

I remember when I first presented it to the NGOs, people came up to me saying that they had been waiting for something like this.

Facilitating an infection prevention and control course to the Liberian county representatives 

Doing a simulation exercise with the National Infection Prevention and Control in-charge at a clinic in Monrovia
“These are the kinds of things that you can only pick up if you are there to see the situation on the ground- it can never be learnt through textbooks.”
2) What made you decide to serve overseas?

I am a big believer in equality. I feel that the most valuable thing to a person is opportunity- the freedom to choose. Regardless of where you are born or who you are born to, it should not limit the opportunities you have and one of the foundations you can never argue with is health. You can argue that they don’t need computers in the mountains but they need basic health care. With good health come opportunities. This was one of the most direct ways that I could offer life to people, so I decided to do medicine. Naturally, I am interested in developing countries because I feel there is a lot of room for empowerment there.

3) How did you decide which niche of overseas work to focus on?

Post-tsunami visit to Yogyakarta, Indonesia, doing post-trauma therapy with the children

Before medical school, I had gone on a few missions trips to China, post- tsunami Indonesia and aboriginal Malaysia. The longest of these was to China for 2 weeks. The main issue I have with these trips is the sustainability or the lack of it. There has to be a long term commitment to be physically there and for me, this is difficult.

So I am trying to fulfil [my desire to help] through other means, like training to be an Infectious Diseases (ID) physician and doing a PhD in infection control research. I believe that influencing policy leads to the most sustainable healthcare outcomes.

4) How can people working on the ground make their trips more sustainable?

It has to be about teaching skills and capacity building. If you are going there to build a school, you might as well teach someone how to build a school instead. It takes a lot of preparation to study what the socio-economic-political setup is in the region before you can deliver what is actually needed. Also, establishing a relationship with the local people is extremely important.

For every overseas trip that you make, it is important to assess the goals first. What can we contribute to the local community? How will it benefit them and ourselves? It is important to build up the skillsets before making the decision to help.

5) Did you have to make any sacrifices along the way?
Doing this PhD is taking time off my training and going out of my comfort zone. Sometimes I wonder what kind of career support I would get if I decide to focus on developing countries and not doing cutting edge science. And my mom is always worried about me being an old maid!

6) What are some challenges you faced on your trip?
It was very difficult to even get to Liberia. I was originally thinking of volunteering with Médecins Sans Frontières (Doctors Without Borders) but the day I applied, their first international staff got infected with Ebola- so they started declining all international staff. Then the WHO opportunity opened up. I had to convince WHO to take me even though I was not that experienced and had to get approval from all levels- my residency committee, my immediate supervisor/programme director, the hospital CEO, the Ministry of Health…(laughs) my family. Then there were the questions of what if I import the disease? What if I fall sick there? In the end, I was very lucky- my head of department had been there twice and said he would supervise me.

On the trip itself, implementation can be very difficult. The education level and concerns are all different. Cultural differences are subtle but can make a project fail terribly. For example, during the Ebola crisis, vaccines went in to help them. But when we were there, there were signboards saying ‘it’s a conspiracy, they are coming to jab Ebola into us!’ A lot of this suspicion is based on the history of the country.

How do you bridge this gap?
You have to build friendships and trust. You must find the key person, whom the people trust. In certain communities, it may be the religious leader, in others the clinic leader.

7) What keeps you going despite the difficulties?
“I feel that we are all here because we are meant to contribute something. We need to find a sweet spot between what the world needs, what we are good at and what we like. Only when we find that sweet spot can we really contribute.”
I haven’t completely figured out what my role should be. But for me, I like to narrow things down. I first decided that medicine was something I wanted to commit to and then that ID was something that could open doors for me. Going on to do a PhD is simply a further exploration of something that I may be good at.

Of course, there are a lot of obstacles along the way. The more you expose yourself to opportunities, the more fatigue and burnout you face. Many days you have no time for yourself and you will begin to ask- ‘What am I doing?’ But you have to learn to re-prioritize- it is all part of a learning journey.

“What makes a person great is not how successful you are at one thing, but being able to tell yourself at the end of the journey that you haven’t given up- that you are still moving towards your goal.”
8) How do you balance your work and personal life?
Someone once told me- ‘find something you enjoy doing and do more of that’. I really enjoy working with my patient population. Because work makes me so happy, I can put my interests aside for a time and focus on my patients. When work is getting tiring and I need to focus on something else for a while, I will do that.

I used to tell myself that I needed to do one run and one reading session each week but it is really difficult to stick to that. So just do whatever keeps you happy.

9) What advice would you give to someone who is considering doing overseas humanitarian work?
To me, helping people is not about going overseas or doing a project.

“It is about brushing up your communication skills, making a connection with another person or spending that extra hour with a patient that has the potential to change his/her life. It is a lifelong commitment.”
Before committing to overseas work, you need to know yourself, your limits and your family situation. You need to know what the needs of others are before contributing. There is a lot to do everywhere. Even for the people right beside you.

Thank you for sharing your experience with us!

If you would like to find out more about Dr Mo Yin’s time in Liberia, you can check out this article or this publication

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