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First mission with MSF – Satish Devkota, MD

After working for almost a decade as a general physician in various public and private health organisations, I wanted to do something new. I had worked in a government hospital, on private projects supported by international donors, in the city, as well as in remote areas. I had been a clinician and a manager. But still the desire to do something else, something more exciting and different, was strong inside me. One fine day while I was surfing the internet I came across MSF India’s website and realised that this was what I was looking for: something challenging and new.

I was impressed by MSF’s objectives and the lengths to which they go to help people in need. I immediately decided that I wanted to work with MSF and, after a two-day assessment, I was selected. Soon afterwards I left for my Preparation for Primary Departure (PPD) training in the Netherlands, which was a wonderful experience. I met people from different backgrounds, different cultures and with different experience, and gained a better understanding of MSF as an organisation. Above all, moving around the “jungles” and streets of Bakkum carrying 15 litres of water as part of a practical orientation exercise under heavy rain – plus the barbecue and party on the last day – was unforgettable.

I had originally heard about MSF shortly after I graduated, but then the scenario was different: I was a new doctor in the town and, with the social status and respect that doctors receive in South Asia, I was enjoying myself. At that time I was also without the skills and experience to work in MSF projects. Now, having gained some managerial skills, significant clinical exposure as well as experience working in resource-limited settings and highly insecure areas, I was eagerly awaiting my first mission with MSF.Within days of completing the primary training I was told that I was being sent to Uzbekistan. I returned home with huge excitement, made all the arrangements, and within two weeks I was in Uzbekistan, an expat medical doctor and a trainee in drug-resistant tuberculosis (TB).

I was surprised to find the MSF project totally different from what I had expected: instead of the very basic conditions MSF colleagues experience in most parts of the world, I found a relatively comfortable, peaceful, and stable surrounding

I was posted to Nukus, the regional centre of Karakalpakstan, which is an autonomous republic in the northwest of Uzbekistan. The main activities that I was involved in were performing rounds on the TB wards with Ministry of Health (MoH) doctors and discussing serious and complicated cases; doing clinical examinations; and having face-to-face chats with TB patients to identify their problems. These problems were related to the side effects of their drugs, as well as their psychosocial condition and their adherence to the treatment.

I also did home visits to serious and disabled patients and spent some time getting used to TB protocols and learning the MSF and MoH guidelines. I also visited the psychosocial, epidemiology and pharmacy departments to get a better understanding of the basic principles of psychosocial support, the data collection and analysis system, and basic pharmacy management issues.

Given the large cohort of TB patients, the high-tech laboratory and the mostly experienced MoH doctors, the MSF TB project provides a great opportunity for learning – not only for TB trainee doctors such as myself, but also for any medical personnel working in the field of TB.

After my three months in Karakalpakstan, I miss Nukus. I miss my housemates, who showed me how to prepare a salad! I miss Navneet’s raita, Yvonne’s pasta, Yan’s Snickers, and Mitchell, who was always there ready to hang out. Thank you guys, for being such wonderful friends.

With unforgettable memories of the Aral Sea, Samarkand, the salty lake and the 1001 Club in Nukus, I am busy (and excitedly) preparing for my second mission to Russia.

-Satish Devkota, MD

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