Working in developing contexts had been a career goal for midwife Jacqui Jones, so when a position came up with Médecins Sans Frontières/Doctors Without Borders (MSF), she was quick to sign up.

“Part of my inspiration for choosing nursing then a midwifery career was so that I would be an asset in countries that needed it. This was the right fit for me after learning about MSF’s values and objectives. The organisation treats anyone in need of medical care, regardless of their societal standing, political views or ethnicity.”

With MSF, Jacqui also found herself drawn to the opportunity to fulfil mentoring and teaching roles and empower local staff.

Over the past three years, Jacqui has worked in Afghanistan, Nigeria, and most recently in Bangladesh where almost 700,000 Rohingya have sought refuge since August 2017.

Jacqui was part of a team responsible for setting up a “Women’s Health Room” in a newly built clinic in the Tasnimarkhola settlement south of Cox’s Bazaar. Established to provide antenatal and postnatal care, family planning, sexual violence and safe abortion care, the clinic’s generic offering made it easier for women to visit.

The team offered psychological first aid, medication and vaccinations to women who had been sexually assaulted or abused. But, as Jacqui explains, “It emerged that what women needed most help with was contraception. We saw women of all ages but many were 18-year-olds, usually because they had already had a baby within the two years beforehand, and didn’t want another baby just now. A lot of them were just coming in to get their next dose, to continue whatever they’d been taking before.”

Jacqui understands that being a midwife with an international medical humanitarian organisation isn’t always easy. “The biggest challenge is not having many diagnostic tests. When I was in Nigeria, we were sending people to get ultrasounds, that were not always accurate. I had scans reporting ‘no cardiac activity’, and then a healthy baby was born hours later.

“Of course, the situations are tough. The worst cases are when you know the patient would have survived if they were brought into an emergency department back home. It can make you feel very helpless.”

At the same time, Jacqui adds that her local team’s drive and persistence, despite their own personal struggles, is the motivation that keeps her going. “It’s a humbling environment.”

“Accepting that working in these contexts is different medicine to back home is part and parcel of the role. For the most part, you are dealing with the same medical conditions, just in a severe state. Pre-eclampsia, premature labour and severe bleeding can affect any pregnant woman. However, there are different ways of screening and treating depending on which country you are in.”

For others looking to work overseas, Jacqui says the best way forward is to set realistic expectations from the get go. “I’m not sure you can ever be prepared for it professionally. You will inevitably find yourself treating patients and conditions that you have only ever experienced in medical books. Personally, you need to be in a good head space, and accept that the work is tough and often with long hours.

“However, it is very rewarding and your colleagues keep you grounded, offering support and a special bond you will never replicate in any other working environment.”

Médecins Sans Frontières Australia is looking for midwives to help deliver medical assistance to the people who need it most. You must be able to commit to a minimum of six months and be a resident of Australia or New Zealand. Find out more on the MSF Australia website: http://www.msf.org.au/join-our-team/work-overseas/who-we-need/medical/midwives

Meanwhile, volunteers with nursing skills are needed on Australian soil too. The Asylum Seeker Resource Centre (ASRC) is currently looking for clinicians to assist with processing medical records of those held in detention such as Manus Island, Nauru and the Australian regional immigration processing centres. The ASRC works with the Detention Rights Advocacy Program (DRAP) who obtains the complete medical records of asylum seekers who require medical treatment but face inappropriate treatment due to their situation. People often require transfer to Australia or in recent times, Taiwan, for specialist treatment and diagnostics, but the bureaucratic and legal approvals they face are endless – which is where the Detention Rights Advocacy Program steps in.

“The Australian government very regularly does not approve these transfers or delays them significantly, which results in people being left in life threatening situations (for example those with acute cardiac conditions), at risk of suicide, or living with chronic pain or humiliating medical conditions that cannot be treated in Nauru and Papua New Guinea. This can happen at onshore facilities too, and we also sometimes see people with serious health conditions deported to their country of origin,” says Natasha Blucher from DRAP.

Through their lobbying, DRAP are able to obtain full medical records of those in need, where volunteer clinicians work with the group to provide a report and recommendation for treatment. These reports generally address what treatment the person has been receiving; whether that treatment is appropriate; what treatment is required and what might be the consequences if this treatment is not provided. The time commitment is flexible - the review plus report takes approximately 5-8 hours. Clinicians can simply nominate when they are available to complete a review, and they will receive those cases that are the most urgent or appropriate to the person's qualifications.

More details can be obtained from the ASRC by contacting them directly through the Detention Rights Advocacy Program coordinated by natasha.b@asrc.org.au or sandra.b@asrc.org.au.