"The role of nurses is absolutely central to MSF"

One area in which MSF has long valued nurses is infection prevention and control—a topic that is getting much wider recognition now in the context of the COVID-19 pandemic.

Another important aspect of our work—and this is also especially relevant in the context of COVID—is with end-of- life and palliative care. Because we accompany our patients throughout their journey, it is often nurses who are present in the final stages of life and at the time of death. In many places, we simply do not have the availability of lifesaving treatments and technologies. Nurses face this reality with our patients every day, and struggle to help people face moments of suffering and death with compassion and dignity, often under devastating circumstances.

What are the mental health impacts of this kind of work?

It’s important to note that nurses are often de facto mental health workers. While I fully support MSF’s efforts to increase specialized mental health care for our patients, we should recognize the skilled mental health interventions that nurses conduct as a natural part of their everyday patient care—active listening; reframing experiences; validating and sometimes sharing emotions.

At the same time, we absolutely need to support the mental health of our nursing staff as well as that of our patients. Imagine working at the bedside in an Ebola epidemic when as many as 70 percent of your patients are dying. Or in a trauma ward in a war zone where children are mortally wounded because they were playing in the wrong place at the wrong time. We must recognize and address the incredible torment—the sense of sorrow and loss—this can create. Nursing is a soulful occupation. We give from the depth of our souls. But sometimes we need help and support in order to help our own and other souls survive.

We should also recognize how resilient nurses are; how tough people have to be to do this work. In Kailahun, Sierra Leone, during the Ebola outbreak in 2014–15, many of our nursing staff returned every night to homes where they likely had no electricity nor running water at the end of their day’s work in a highly contagious disease ward. One day, as the outbreak was winding down, the staff were talking and playing this grim game—which was worse, Ebola or the country’s civil war? Remember, this was a war in which limbs were deliberately amputated. One woman on our team said, “Oh, Ebola has been much worse.” Her colleagues were surprised until she explained, “For the past year, I have not been able to hold my children.”

That really affected me. Nursing was her job. But I had never recognized the depth of the sacrifices, the incredible selflessness that brought her and so many of her colleagues back day after day, to work that could have cost her or her family their lives.

Now, in your role as an MSF-USA board member, how are you thinking about supporting our staff and strengthening health care capacity in low-resource settings?

One thing I’d like to do is strengthen the representation of nurses within MSF, to recognize current nurse leaders and identify new opportunities for nurses in leadership roles. More broadly, we need to recognize and develop the talents of people throughout MSF who are leaders, who have been working in our projects in some cases for years. I hope we can promote more locally hired staff into leadership roles and elevate the work of local experts.

Now of all moments we must look at how to do things differently. Response to sudden change — this is what MSF is all about. For example, in the face of travel restrictions, perhaps we could consider how much travel is really needed to accomplish our goals. Couldn’t this be the moment to concentrate on remote training and support for local staff? Perhaps this is the moment to combine the strengths from diverse settings to improve nursing throughout our medical projects.

Some people have said we should be “Nurses Without Borders” to recognize the vital role of this profession. What do you think?

Our title, Doctors Without Borders, suggests the hierarchical importance of a single role to the apparent exclusion of others—and, as a nurse advocate, I have always railed against that. What I really think is that all roles are critically important. Who working on an MSF project could live without a logistician or a WASH [water, sanitation, and hygiene] specialist? We have just been talking about the importance of mental health, about being connected to communities—what would we do without psychosocial counselors, health promoters? How would we manage our activities without our drivers, our cooks and cleaners, our human resources and finance managers?

So, yes, it’s important for us to raise up the profiles and voices of our nurses and midwives—absolutely! But it’s also important for us to recognize and credit the contribution of every single role, every single member of every one of our teams.

We talk about the incredible value of diversity in our organization. We say we are, and I truly believe we are, committed to equity and inclusion among patients, communities, and staff. Now, with the disruptions caused by a worldwide pandemic, and the stark realities of racism and health disparities glaringly obvious here in the US, we are called to right action: to raise up the contributions of every employee, to recognize the humanity of every patient; every being we touch. As nurses, we are bound by our profession and driven by our ethics to provide care with compassion and respect for the inherent dignity and value of every person.

>> Read more from Alert Summer 2020: Nurses and midwives on the frontlines.