May 10, 2016 – Sharon Janzen – Doctors Without Borders

Sharon JanzenSharon Janzen is a Registered Nurse and Sexual Assault Nurse Examiner who completed her first medical humanitarian mission with Medecins Sans Frontiers / Doctors Without Borders (MSF) in Somalia. She then returned to the field and spent time in a refugee came in Darfur, Sudan and helped to establish a sexual violence response program. She was in Sri Lanka after the Tsunami and has worked as a consultant for trauma and urban violence programs in both Liberia and the Delta of Nigeria. Before working with Doctors without Borders she was a part of two surgical missions to Guatemala with a different non-governmental organization (NGO).

When Sharon is not on mission with MSF she divides her time between the Clinical Prevention Services of  the BC Centre for Disease Control and BC Women’s Hospital Sexual Assault team. Sharon also teaches at Vancouver Community College for nursing students completing their global health module and is a contract teacher for BCIT for the Women’s Reproductive Cervical Screening Course.

The MSF website is www.msf.ca

 

Notes on Sharon Janzen’s presentation – by Peter Scott

Past President David Scott introduced our guest speaker, Sharon Janzen.
Sharon spoke passionately to us about her involvement with Medécins sans Frontières, better known in North America as Doctors without Borders. She feels passionate about the work that MSF does and regards it as the leading NGO in its field. Sharon has done 5 missions with MSF and has been involved in Conflict Zones, Post-conflict Zones, Refugee camps and more urban concentrated areas.
MSF was founded in 1968 by a group of French doctors working in, what was then, Biafra, a region of Nigeria, which had declared its independence. This started what became known as the Biafran War which ran from 6 July 1967 until 15 January 1970. It was these doctors’ wish to start a neutral emergency humanitarian medical organization that would speak out for populations in distress. This is what separates MSF from all the other organizations that are doing humanitarian work in conflict and disaster areas. MSF is impartial and neutral. Its services are open to all regardless of gender, race, religion, sexual orientation or even which side of the conflict they are on. Last October, one of its trauma hospitals in Afghanistan was accidentally bombed by NATO forces, killing several people including 9 medical staff. MSF’s impartiality extends to how they conduct their business. They refuse to take donations from the large oil companies working in areas where MSF operates or from pharmaceutical companies which may wish to push their products. MSF adheres to the principle of medical ethics; when they practice in the field, they use first-line, WHO recommended practice to treat specific diseases and infections. They do not use expired drugs; they buy what they need to fulfil their projects, thus allowing them to speak out against the big pharma companies. MSF operates in 19 countries worldwide, including MSF Canada which designed a program which allows practitioners in the field to use the internet to help diagnose illnesses with which they are unfamiliar. During the recent Ebola epidemic, families would bring sick relatives into the hospitals. Due to the highly contagious aspect of the disease, they would leave them there and often never see them alive again. There are very specific burial practices which must be followed after a death in an attempt to control the spread of this disease. Rumours and myths prevail in these parts of the world and people, not knowing what had happened to their loved ones, wouldn’t be able to grieve and have closure. So MSF Belgium designed a facility using plexiglass walls to contain the patients so that the family could spend time with their relatives as they either declined or hopefully, improved. As another example of the MSF accountability, we were told that during the 2004 tsunami in the Indian Ocean, donations to MSF had reached the point where they didn’t require any more for the victims of that event. Circumstances in those countries affected were such that immunizations, hand-washing techniques, etc. were up to standard so the risk of infection was thus significantly reduced.  So MSF pleaded with people to make donations to the Emergency Funds for use in the more at-risk regions.
Sharon’s first of five missions for MSF was to Somalia which she describes as one of the more challenging countries in which to work. When she was there, the reign of anarchy and the failed state existed and still exists today; no centralized government or legal system, no judges, lawyers or police, everything was run by tribal law. Being a typical Muslim country, women have little access to proper medical care and in fact, at that time, very few qualified medical practitioners were left. MSF had to find people who could at least read and write, to perform basic tasks such as taking blood pressure readings. MSF’s work involved dealing with the most rudimentary of medical care; amputations, C-sections, dealing with difficult births and checking malnutrition in children. MSF is not, at present, operating in Somalia due, in part, to two of its employees being kidnapped and held for ransom for two years. They hope to return when they feel it is safe. MSF is continually working to ensure, as much as possible, the safety of its employees.
Sharon’s second mission was to Darfur, another but quite different, Conflict Zone as it was set up more in the style of a Refugee Camp. Darfur is primarily made up of two ethnic groups, those of African descent, traditionally farmers and those of Arabic descent, traditionally nomads. When the two groups are forced to move due to drought, conflicts arise and here, millions of people were forced into refugee camps and there were an estimated several hundred thousand human casualties from combat, starvation or disease. Here, Sharon was working with MSF Switzerland. People arrive in refugee camps without even a bucket for water, no blankets or mosquito nets, all items of necessity in any African country and providing them is as important as the immunization and other programmes provided by MSF. Sharon showed a photo of a refugee camp’s tiny huts that would often accommodate up to 12 family members. Sheets of tin and tarps, provided by MSF, give some degree of comfort inside the huts during the rainy season.
Sharon then spoke to us about the recurring theme of sexual violence, frequently used as a weapon of war during these conflicts. She described the Rwanda situation during the genocide in 1994 when thousands of women reported abdominal problems which turned out to be related to STD’s and AIDS all as a result of rape. While dealing with these diseases can be achieved, dealing with the emotional side is more difficult. Back in Darfur, though, it was much the same and while the area is still in conflict it is overshadowed by the fighting in South Sudan. Sharon’s next mission was to a Post-Conflict Zone in Liberia, which had been in a civil war from 2003 until 2005, when UN Peacekeeping forces embarked on their largest peacekeeping mission to date. At the end of 2005, in a democratic election, regarded as the most free and fair in Liberian history, Ellen Johnson-Sirleaf was the first woman elected as President in any African nation, a position she still holds. By 2007, the people were giving up their weapons freely. It was here that Sharon saw a billboard showing, in graphic animated detail, what happens during a sexual assault. This campaign started a movement against such assaults. A major point which Sharon made, was that with the huge number of GOs and NGOs operating on Liberia, MSF is the only one providing medical care to victims of sexual assaults. Unfortunately, this also created a problem for MSF, as the justice system was calling upon Sharon to testify in the court proceedings. Eventually she was able, by working with the Liberian government, to create a Liberian government certification system that allowed their own people to testify, thus putting MSF at arm’s length from the courts. MSF left Liberia after 19 years, on good terms and was able to return last year to assist with the Ebola crisis.
Sharon continued by describing her mission in Nigeria, her last, where MSF encountered the same or similar problems to those found in the other countries: corruption, exploitation of the people by the oil companies operating in the Delta area where MSF was working, what was happening with the huge amounts of money generated for the government by the oil, etc. In Nigeria, many of the patients MSF dealt with were gunshot victims, shot from close range directly into the joints, knees and elbows in particular, which invariably required amputation. MSF established a highly sophisticated hospital with 2 surgeons, one general and one orthopedic, who were rotated in and out every 6 weeks.
MSF employs many people who are not involved in the medical side; lawyers and HR people to look after contracts and ensure that staff are paid according to the law, managers and financial experts for budgeting, engineers for water sanitation etc. and logisticians to ensure that everything works. We were also told that by utilizing the protocols set up by MSF, they are able to go into an area and reduce the mortality rate from Cholera from 50% to 5% in 3 days.
We were encouraged to google “Not a Target” and go to the MSF website to see all about their on-going media campaign.

Questions and Answers
Q. Given the situation which happened with the hospital in Kunduz, doesn’t MSF have an icon like the Red Cross and Red Crescent to identify hospitals etc from bombings?

  1. MSF is proud that they do not operate with armed security, with the exception of Somali where they have to. They do have their distinctive logo, which is used extensively on tents, hospitals, uniforms etc. Until recently this was a well-respected symbol. The coordinates of hospitals were given to all the warring factions involved, including NATO. The exact reasons that this hospital was bombed are still not known for sure. However, this practice has back-fired leaving hospitals vulnerable and they have discontinued the practice. One of the problems that MSF has, is that when they set up a mass immunization programme, publicized via social media, they tell the enemy where there will be a large gathering of people which makes these locations a perfect target. A couple of years ago, in Syria, they had to operate these for a maximum of one hour and treat as many as possible, then close up and set up at a different location the following day.
  2.  How did a young nurse from Canada end up in Somalia and did it take a huge emotional toll?
  3. After assuring us that she wasn’t that young, Sharon wasn’t sure how she ended up in Somalia, other than to say that it was serendipitous – that was the placement which was chosen for her. She explained that, on arrival, she wanted to do the “job description” which, she said, made it sound quite lovely, describing being able to take walks in the local hills on days off. After the first experience walking in the local hills, she almost came in contact with a lion, which dampened her enthusiasm for that activity. Days off were rare anyway as their four person team was working more or less around the clock. Added to that, they weren’t able to drive anywhere due to the safety concerns. Having said that, though, she really appreciated the opportunity to be there as there was no question as to why they were there. Her time there also helped her to understand the security issues and other important factors of being in a Combat Zone for here future missions. As for the emotional toll, Sharon told us that she has a wonderfully supportive family and was able to reintegrate very well on returning from a mission. She always felt that she lived in a world of access and returned to a world of access. She feels that it is the same as dealing with sexual violence in Vancouver. She has a mandate – she cannot solve the problem in the city but at least, at the time, she can be there for that victim – that is how she approaches each mission. She does whatever she can when she’s there but tries not to be haunted and filled with guilt when she comes home.
    Sharon then described the Peer Support Network which MSF has. Volunteers returning or heading out to a mission are able to contact others who have been or are going, into the same or similar situations and this helps them enormously to deal with any emotional issues on their return, or prepare for the particular mission to come.
  4. How big is the organization in Canada compared to the how big it is globally?
  5. In Canada, most of the administration is centered in Montreal and Toronto. Each office there has at most 30 people. Last year, they sent about 375 people to various projects in the field, interesting when compared to the much larger US, which sent 420! Globally, there are fewer than 200 staff in the operational sections in the headquarters, and about 4’000 national staff. MSF will also single out exceptional workers and use them in different missions in other parts of the world.
  6. How long do you provide food for those who come to you dying of starvation and does MSF have problems with corruption?
  7. Sharon was a pediatric nurse at Children’s Hospital for 10 years and seeing kids with malnutrition or with any other diseases leaves a lasting impression. During her various missions, she saw kids die of starvation, tetanus, cholera and a host of other problems, which is abhorrent to her as a pediatric nurse. Specifically in regards to starvation, there is no magic formula for how one copes, it’s hard every single time. At the same time, there may be days when it seems everything is going to wrong way and you are losing patients but often, these are followed by days where the opposite happens. However, there are very specific protocols in place in terms of how to deal with this problem and the kids will be kept nourished for as long as they are “in the game”. More difficult are the rare triage situations where MSF doesn’t have sufficient supplies to deal with a sudden, large influx of patients. In these situations, you have to decide who is more likely to do best and who is not.
    Corruption is a daily problem. It can start with something as basic as a national employee not wanting to wait for test results and so take the required items and performs the test without telling anyone. This can lead to taking large quantities of drugs and selling them on the black market. Due to the checks and balances within the MSF organization, compared to other NGOs, it is more difficult for this to happen, but it can and it does. They also have to deal with the corruption of governments and have to make difficult decisions such as, if 30% of their supplies are being diverted, is it still worth their presence if they can get 70%.
  8. Are there any MSF projects in Canada?
  9. No. there have been questions asked as to why MSF hasn’t offered services on any of the aboriginal communities or some of the reserve lands.

Dr. Hugh Chaun thanked the speaker and presented her with the customary honorarium.

 


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