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What do you need to know about working overseas with MSF?

Introduction by Croakey: What does it take to be qualified and suitable for an international assignment with a group like Médecins Sans Frontières (MSF)?

A webinar this Wednesday (17 May) from 6-6.30pm (AEST) will explore different pathways to working with MSF and what the experience can involve and teach, as Croakey editor Dr Ruth Armstrong reports in this preview of #AskMSF for the Croakey Conference News Service.

Some of the advice from MSF veterans includes learning a language, being highly adaptable, and having clear motivation. Importantly, MSF says it is not just looking for clinicians, but for a range of non-medical recruits too.


Ruth Armstrong writes:

Dr Adelene Hilbig, an emergency medicine registrar based in Mparntwe/Alice Springs, spent six months of her pre-clinical training in Malaysia as part of an exchange offered during her medical degree at Monash University.

The experience fuelled a longstanding interest in working overseas – experiencing, contributing to and learning from the ways different regions and countries deliver healthcare to their populations.

Interspersing her training in emergency medicine with assignments for Médecins Sans Frontières (MSF), Hilbig has undertaken three overseas stints in the past six years – in Sierra Leone, Palestine and Myanmar.

Isaac Chesters put aside a teenage dream of working for MSF when he realised he wasn’t keen to study medicine, but he maintained an interest in international affairs and a desire to work for an international non-government organisation (NGO).

A science, law and language graduate, he took on a role in MSF’s Sydney office as a field departures coordinator before departing himself, on assignment to Bangladesh and then Chad, as a Finance and HR Manager.

Hilbig and Chesters will explore their different pathways in working with MSF at a webinar this Wednesday, 17 May, which presents a unique opportunity for people interested in working with MSF to fire away any questions they might have about the recruitment process, fieldwork and overall experience.

Their stories represent two different pathways taken by Australians who have worked overseas on projects run by MSF, and there are many others, MSF says.

For some, the idea joining a humanitarian project abroad has been a longstanding “niggle” that persists through a long domestic working life. For others it’s a carefully planned process of acquiring the right knowledge and skills to make international humanitarian work a career, and for a few, it’s a matter of being the right person at the right time to fill an important niche.

MSF Australia recruiter and organiser of the webinar, Jacqui Clark, told Croakey that the organisation is currently looking to recruit Australian and New Zealander mental health specialists, infection prevention and control managers, gynaecologists, anaesthetists, surgeons, paediatricians and midwives to undertake international assignments, which typically last nine to twelve months but can be shorter for some medical specialists.

But she stressed that there’s also a need for people to fill non-medical posts overseas – in the broad and multiskilled roles of finance/human resources managers and logisticians.

“None of these projects are going to work if there’s not someone there to oversee all the administrative side of things,” she said. “To do the recruitment, the payroll, the contracting, the insurance… Even the best paediatrician can’t do their job properly if the generator’s not functioning and there’s no electricity.”

Clark emphasised that the webinar is open to anyone who is interested in working overseas for MSF at some point, even if they are not in one of the groups currently being sought. “The needs are changing all the time,” she said, advising the best way to keep up is by signing up to the monthly Field Human Resources newsletter on the MSF website.

Skilled up, par excellence

Regardless of background, there are qualities that MSF looks for when recruiting for overseas roles, the webinar will hear.

Hilbig advises that being strong and secure in your own clinical practice is a prerequisite for taking your skills overseas. Even in post-graduate year four, with communicable disease and remote emergency medicine rotations under her belt, she believes it would have been beneficial to have had more clinical experience before heading off on her first assignment to Myanmar in 2017.

“It comes down to being more comfortable and confident in your own clinical processes in order to also support others to develop,” she said.

“With some of those skills around synthesising information and building that into management plans, you need to be quite strong in your own clinical practice and the more senior I get the more I recognise how important that is.”

Adelene Hilbig

In Chesters’ case, skilling up included a four-month intensive language course in France, before heading off for nine months in Chad as Finance and HR Manager of a project where no English was spoken.

“It was something I really wanted to do almost from when I started working at MSF. I knew that a lot of our projects were in French, and it was a personal challenge I really wanted to undertake,” he explained.

He said the first few weeks were incredibly difficult but that he was able to reach a “practical point” where his French was good enough to get the job done.

Clark told Croakey that proficiency in a second language – particularly French – makes medical and nursing staff much easier to place in overseas programs. Other priority languages are Spanish, Arabic and Portuguese.

Adapting and shapeshifting

Clark believes adaptability and flexibility are essential if you plan to work overseas for MSF.

“Even the day you fly out things might change,” she told Croakey. “There’s a lot that can change in the context we’re in, so if you’re someone who really likes things in a certain way then maybe MSF’s not the place for you.”

Chesters agreed. “To work as a Finance and HR Manager, one of the most important characteristics is the ability to work with ambiguity, to work with information that’s incomplete, to be totally flexible,” he said.

An example from his time in Chad was that, at one point, all the Chadian doctors were suddenly recruited to work in government facilities. While the boost to the public workforce was arguably an excellent move for the country, the loss of core medical staff created a massive and instant HR issue for the MSF project.

Isaac Chesters

Hilbig, who has moved between jurisdictions in Australia as well as undertaking her three MSF assignments overseas, is the ultimate clinical shapeshifter.

She told Croakey:

When I go, as well as when I come back, I need to rely on my peers and senior colleagues to help me recalibrate my clinical practice a little, in the sense that things are done differently everywhere.

You’ve got different investigations or different treatments… It’s a very similar process of making sure that I understand the system in which I’m working and how we deliver healthcare in that.”

Teaming up

Hilbig noted that joining an overseas project for MSF means joining a team, and taking the time to find out how it works as well as your role in it.

In 2021, globally, 83 percent of all MSF employees were locally hired field staff, and this percentage is increasing as MSF continues to seek to build capacity where it is needed.

In Chesters’ view, the balance between international and local staff on any team is important. He described his time as the only international staff member with a Bangladeshi team including a boss who had been working on the project for 10 years as “fantastic”. “No international staff member in a short period of time can gain that knowledge and experience,” he said. “It takes years.”

But international staff who have worked around the world in multiple contexts also have much to give, he said. “They have a big picture perspective on the humanitarian response, so when you partner effectively with people who understand the local context well, it can lead to really good quality output.”

Chesters told Croakey that, in the past few years, MSF has begun to send fewer international staff from countries like Australia, Europe and North America on assignment, in favour of sending more staff from the countries where MSF has projects to other countries where international staff are needed.

He said that, while these staff might not immediately understand the specific context of the country to which they are assigned, they bring with them real world experience of living and working in a place with health and humanitarian issues.

Sierra Leone: MSF is supporting the Ministry of Health and Sanitation’s malaria bed net distribution campaign in the chiefdom of Wandor, Kenema District: Photo: MSF/Tom Casey

Another upside of being part of an MSF team is that it imparts vital support systems for those on overseas assignments.

“I felt that in particularly in Chad because it was a context that was very, very difficult to explain to my friends and family,” he said.

“My support network was my colleagues who were right there and who I could talk to every day, because I felt – and I think a lot of people feel like this – they were the only ones who could truly understand what it was like to work there.”

 Hilbig’s support team extends all around the globe.

“Through working in different places and different contexts I’ve built a network of people who have some shared experiences – different experiences, shared experiences apart, together apart,” she said.

“Being able to call on them and talk to them about unexpected situations, or recalibrating when leaving or coming back, is probably one of the most useful strategies.”

Engaging mindfully

Both Hilbig and Chesters have been strategic in their approach to work in Australia, and overseas for MSF. Hilbig believes that nurturing both has turned her into a stronger clinician.

As she nears the end of her training with Australasian College for Emergency Medicine, she is grateful for the opportunity to move between the two.

“Clinically, there is a transferability for emergency medicine in terms of a combination of medical skills and leadership and management skills,” she said. ”It’s very two-way. I learn skills here that are very useful on assignment, and I learn skills on assignment that are very useful here.”

Chesters reiterates that linguistics/second language skills open doors for those interested in embarking on overseas work for MSF. Other than that, the skills that are useful for working in non-medical roles for medical projects overseas are “incredibly broad”.

“For example, we have logistic experts who come from a diversity of backgrounds – everything from tradespeople to engineers to other types of project managers.”

He urges those interested not to underestimate how transferrable their private sector skills can be to the non-profit sector.

“There’s a difficult readjustment in how you think about your work, but we still see so many people come from the private sector who are very effective in their roles.”

Sierra Leone: MSF health promoter Mohammed Turay delivers a health sensitisation session as people wait to be seen by a community health worker in the village of Mbaama, Kenema District: Photo MSF/Tom Casey

A final word of advice from Chesters is the importance of understanding your own motivation before talking on international assignments such as those offered by MSF.

“Some people float into humanitarian aid out of a desire to do something that’s adventurous or a bit different or something to add to their CV, and it’s not a good enough motivation because it can be extremely challenging and it can really, really push you,” he said.

“If you don’t have the right motivation, you’ll struggle to get through a difficult assignment. Remember that the assignment will never be about you. You’re a small cog in a big machine that’s doing good work; a little piece of an enormous puzzle. You’re just a part of a huge team, all working towards the same thing.”

For those who are motivated, criteria for international roles are set out on the MSF website, as well as the answers to common questions.

Clark’s advice is to keep in touch, keep preparing and keep it in mind, whether or not you are a health clinician.

“If you love public health and you’ve got the right skills, we’d love to hear from you.”


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