Practical Advice from a Doctors Without Borders Nurse

Rebecca Singer, R.N., N.D., has been working with Doctors Without Borders since 2005, helping survivors of violence get the care they need in countries like Chad, Liberia and Papua New Guinea. Not only does she offer medical assistance, Singer has advocated for policy changes and helped develop better relations at places where health intersects with the government, law and society. Singer spoke to Professor Diamond’s Achieving Global Impact Through Local Engagement class recently, giving students some helpful tips about working in the global health field.

Know What You Want
In the realm of global health, you don’t necessarily need medical training to make an impact. “Anyone can do any of the things I did for the most part, and anyone can do and work on the types of projects that I’m talking with all different skill sets,” Singer said. In both the realms of development work and humanitarian work, there are plenty of options to get involved. Both have their advantages and disadvantages, according to Singer. It’s important to know what kind of a role you want. “[With] humanitarian response you are responding to a disaster of some variety, a crisis,” Singer said. “If you’re working in humanitarian work, it tends to be less comfortable. You have to be comfortable without internet, without access to phones, without a room of your own, without flushing toilets.” Humanitarian work is also normally shorter in duration from development work; responders typically get to see the impact of their work, saving lives or otherwise, and then leave. Assisting with developing systems requires more time and can get predictable, according to Singer, as building systems can last indefinitely. However, it has the added benefits of being able to live with a community and enjoy a more stable lifestyle.

Learn Before You Go
Always research the location of your future work, as well as the agencies you’ll be assisting before you go anywhere. “For me I think that the key step in any of the work that I have done is that assessment piece,” Singer said. “It’s the time when you’re going to learn about the context in which you are working in order to maximize the resources that exist and in order to be able to plan and implement an appropriate response.” While speaking with health professionals and workers in the area is helpful, try to go beyond the medical background. “Often times the doctors and nurses and health workers in general at the health center know all the statistics about who walks in the door – what sorts of problems they have and what sorts of medication they were given,” Singer said. “They don’t necessarily know the conditions under which people live, the things that might have happened, the health beliefs they have and the behaviors they might have engaged in prior to waking in that [hospital] door.” This kind of information will help you deliver a better response that can resonate with the community.

Include, Don’t Exclude
“It really does take a very wide net with lots of stakeholders with lots of people from lots of different professions and lots of different specialties in order to implement almost any program,” Singer said. When planning any effort, try to engage as many people as possible, from religious leaders to women’s groups. Singer described her experience trying to build a clinic to help respond to sexual violence in Papua New Guinea. As part of the project, the clinic workers developed relationships with court systems, law enforcement and community leaders to help women get referrals and strengthen laws and law enforcement in issues relating to sexual violence. They also spoke with safe houses and child care workers. “We could never do this work alone,” Singer said. Cutting out any group leads to a risk that the project could fail or not turn out as well.

Be Ready for Anything
“No matter what you do, all the good planning, all the good assessment, when the intervention time comes, you have to be patient, you have to flexible and you have to be ready for anything,” Singer said. “It almost never goes as smoothly as you think or as neat as it looks on paper.” Singer realized all this herself when working in the Democratic Republic of the Congo, helping plan and implement a large-scale vaccination campaign in which a caravan of cars would deliver supplies to a number of communities. “The night before we started it rained harder than I had ever experienced rain for about eight hours straight,” Singer said. The roads turned to mud, creating serious problems for the program. “We got to our sites three hours late and we dug the cars out how many times.” Singer said that the team stuck with the project, navigating the difficulties as best they could. “You’ve got to pivot, you have to figure out what to do, and you have to be patient,” Singer said.

Count Things Differently
“The key to evaluation is really asking the right questions – where do we want to go what do we want our outcome to be?” Singer said. “We have to know where we are going and right from the start how are we going to measure that, how are we going to tell if we are successful.” Sometimes the ultimate health outcomes of a project will not be immediately clear, which necessitates a different standard of measuring impact. Singer said to look to other indicators, from measuring comprehension to accessibility to get a better understanding of the benefits or disadvantages a program carries.

Speak Up
Doctors Without Borders has long been an organization linked to advocacy, according to Singer. The group is known for speaking out about human rights abuses, and refusing to operate in conditions where they believe injustice is occurring. Anyone working in global health can and should advocate for those they serve and their values. “It’s really important that you keep the reasons that you are doing this work – your true north – it’s not about the numbers,” Singer said. “Take a step back and remember the big picture and then use your voice to speak out.”

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