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F or medical doctors, Médecins Sans Frontières (MSF) provides an opportunity to spend time in developing countries and work intensively and directly with patients. Next Wave Germany Editor Eick von Ruschkowski talked with Dr. Thomas Finkbeiner from Tübingen, who has been in Africa with MSF, to learn more about the organisation's activities and its work in the developing world.

Next Wave: Dr. Finkbeiner, to which countries have you already been with MSF?

Finkbeiner: I have been on four different missions so far. I was in Tanzania in 1994, Rwanda in 1996, and the Congo in 1998. Most recently, I was in Sierra Leone in 2001. Each individual stay lasted between 3 and 6 months.

Next Wave: What is your academic background?

Finkbeiner: I studied medicine in Tübingen. I am currently specialising in the field of paediatrics and have been working as a physician at the University [of Tübingen's] Children's Hospital for the past 8 years.

Next Wave: How do doctors like you get into the MSF programme to volunteer in developing countries?

Finkbeiner: The typical way in Germany is that people call the MSF office in Berlin or apply through the MSF Web site. After the first contact has been established, the candidates get the formal application forms, which they need to complete. Later, they will be invited for a personal interview.

Next Wave: Can any doctor potentially volunteer with MSF?

Finkbeiner: Well, there are some formal prerequisites candidates need to fulfil. First of all, you need to have 2 years of work experience,* and you should have work and/or travel experience in developing countries. If you want to work as a surgeon and anaesthetist, you need to have completed your specialisation. Also, you need to show an interest in and respect for other cultures, and you need to speak English. The more languages you speak, the better.

Médecins Sans Frontières

Médecins Sans Frontières ( MSF) is an international, independent humanitarian aid organisation. It provides emergency medical assistance to populations in danger in more than 80 countries where health structures are insufficient or nonexistent. MSF collaborates with local authorities to provide assistance. Doctors work in rehabilitation of hospitals and dispensaries, vaccination programmes, and water and sanitation projects. MSF also works in remote health care centres, slum areas, and refugee camps and provides training of local personnel. All this is done with the objective of rebuilding health structures to acceptable levels. It is part of MSF's work to address violations of basic human rights encountered by field teams. MSF has been setting up emergency medical aid missions around the world since 1971. Their longtime activities were honoured with the Nobel Peace Prize in 1999.

If you are interested in working for MSF, contact MSF in your country. The German section, Ärzte ohne Grenzen, is located in Berlin.

Next Wave: What does "travel experience" mean exactly?

Finkbeiner: Well, if you have only been on package tours to Mallorca or the Canary Islands over the past 15 years, you should think again about applying. Travel experience means that you should have done independent travel for extended periods. Personally, I spent several months in East Africa as an intern while I was a medical student at the University of Tübingen.

Next Wave: Which languages should candidates speak?

Finkbeiner: That certainly depends on the region they are planning on going to. Although French is the official language in some countries, the primary language spoken on missions in general is English. From my experience, it helps to refresh your English vocabulary before you go, because the team language is English. You also need to be able to participate in more complicated conversations, especially when you have to take over representative tasks.

Next Wave: So which languages do you speak?

Finkbeiner: I speak English and French. Also, I can communicate in Swahili, but only basic. I learned it when I was in Africa for my internship. I also know a few bits of other African languages.

Next Wave: What's the practical work in Africa like? What are the duties for an MSF doctor there?

Finkbeiner: The work we do is very diverse and can include management and supervision as well as direct contact with patients. The degree of effectiveness is very high. We usually work in small hospitals. Many times, the work is centred on refugee camps. Besides treatment, we also set up and monitor preventative health programmes, such as vaccination, nutrition, or care for pregnant women. Compared to Germany, you have far less technical equipment to support your work, so it is more hands on.

Next Wave: How many MSF volunteers usually work in one place?

Finkbeiner: The core team usually consists of a logistics person, a field coordinator, a nurse, and a doctor. For security reasons, the international teams are kept quite small, because it is easier to evacuate them in case of an emergency. We are also not trying to build new permanent structures with the people we send there; the primary goal is to do relief work. When our work is finished, we usually hand the responsibilities over to local nongovernmental organisations [NGOs] or the ministry of health. But for refugee camps, MSF volunteers might stay for extended periods of time.

NextWave: How much do you cooperate with local people?

Finkbeiner: Usually, the number of local doctors and aides exceeds that of the MSF volunteers by a factor of 20, so we cooperate quite a lot. We assist our colleagues and try to develop standard procedures that make the work easier. Local colleagues want to learn how to optimise treatment methods. We also work a lot in the field of preventative medicine and epidemiology. We also cooperate with local NGOs, mostly those working in the field of medicine.

Next Wave: What are the problems you encounter there?

Finkbeiner: I have personally had a great experience with highly motivated local colleagues, but sometimes it can be difficult because they have often been through terrible personal experiences, which makes it difficult for them to return to business as usual. Also, MSF tries to put its own international staff in key positions. Pharmacies are a good example. The distribution of medicine and drugs is an important task, but if local people had this responsibility, they would be under a lot of pressure because everyone is in such desperate need. So we try to reduce this problem by putting internationals in charge of these areas.

Next Wave: Do MSF volunteers get paid at all or are they working for free?

Finkbeiner: Working for MSF is meant to be volunteer work, not to get rich. However, everyone gets paid for air fare and accommodations in the host country. Additionally, a monthly allowance of ?600 is paid to cover running costs in your home country.

Next Wave: For you personally, which experiences have had the most emotional impact?

Finkbeiner: My mission in Congo was a very intense one in terms of what the refugees were reporting about what they had gone through. In a positive sense, last year's stay in Sierra Leone sticks in my mind. We came there when peace was suddenly in reach, and we helped on both the government and rebel sides. It is a great experience to see how much of a stabilising factor for a country medical aid can be. This is why overall working for and with MSF is very rewarding. You are working directly with the people, with the patients. You cannot rely on all the expensive devices you find in a European hospital, so improvisation is often necessary. And one more positive factor is that you don't have to deal with as much administrative stuff as you have to at home.

Next Wave: What are your personal goals for the future?

Finkbeiner: I am planning on going to Africa again. But first, I am in the middle of preparations for a 1-year stay in the United States, in New Orleans. At Tulane University, I will try to do my master's in public health. I am lucky, I received a 1-year fellowship from the German Academic Exchange Service ( DAAD). I am certain that this program will help me gain more valuable knowledge for my overall career, but especially for work in Africa.

Next Wave: Good luck and thank you very much for answering our questions!

* German applicants need to have completed their AiP (Arzt im Praktikum).