Doctors Without Borders: First-Hand Account
Guest: Dr. Caroline Thiedke – Family Medicine, MUSC
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: This is Dr. Linda Austin. I’m interviewing Dr. Caroline Thiedke, who is Clinical Associate Professor of Family Medicine here at the Medical University of South Carolina. Dr. Thiedke, you’ve had a very interesting career. And I understand that you were on the faculty here at MUSC for, how many years?
Dr. Caroline Thiedke: For eight years.
Dr. Linda Austin: Eight years. And then you went and worked with Doctors Without Borders?
Dr. Caroline Thiedke: That’s correct.
Dr. Linda Austin: So, tell us about that experience.
Dr. Caroline Theidke: Well, I had been an admirer of Doctors Without Borders for many years and it was a long-time dream of mine to work with them, if they would have me. Then, two or three years ago, a close friend of mine died, and it was one of those moments when I said, you know, if there’s something you really want to do, you ought not to postpone it. So, I started looking into what it would take to work with Doctors Without Borders.
I applied, went to New York for an interview, and then went through an orientation period for a few days, in New York. And then, in mid March of 2007, they called me and said that they had an assignment for me, and sent me to Milawi, which is in southern Africa, to work on an HIV project.
Dr. Linda Austin: Boy, that must have been a major challenge. Tell us about that. What did you do there, and how long were you there?
Dr. Caroline Thiedke: I was there for six months. It was a challenge. I worried because I had not done HIV care here in the states, but felt that if Doctors Without Borders was asking me to go there; they knew what my qualifications were, they would probably make sure I had the resources I needed, which they did. They had very clear guidelines for us to use. And I became comfortable treating patients with HIV within a few weeks.
I worked in the outpatient settings. So, my work there looked very similar to the work that I did here in Charleston, in that I was in an exam room and, one by one, patients would come in to see me. But, of course, all the patients that I saw there in Milawi were people who were HIV positive. We saw men, women, and children. We were able to give them the ARVs, the medications against HIV, at no cost to them. Many of our medications were provided through Milawi’s government, who obtain them from the Global Fund. The Global Fund is an organization with donors from many places. There are governmental donations, the United Nations, the Bill & Melinda Gates Foundation. All of these various agencies contribute to the Global Fund. And then the Global Fund, in turn, provides medications for HIV, malaria, and tuberculosis. And I worked with all three of those in Malawi.
Dr. Linda Austin: What did you feel you were able to contribute by that experience?
Dr. Caroline Thiedke: You know, that’s something that I reflect upon. You know, I think it’s only human nature to wonder, did I make a difference, in the six months that I was there? And, of course, I think it’s human nature to say, well, yes, I did. I think that, certainly, I saw a volume of patients. We would see as many as 40 or 50 patients per day; and there were two of us. So, we would see anywhere from 80 to 100 patients per day in our clinic. I think we were able to deliver high quality care.
I felt that the skills that I learned as a medical student, and a resident, you know, how to treat patients with respect and dignity, I brought with me to Malawi. And I hope that I conveyed that to the patients that I saw so that they felt that they were being listened to and taken seriously. You know, Doctors Without Borders, one of their key principles, one of their founding principles, is something that’s called témoins des ages, which, in French, means witnessing. And so, Doctors Without Borders feels that it’s important for people who volunteer with them to be witnesses to the humanitarian crisis that they see. And I think I’ve certainly done that. And I hope that I conveyed to the patients in Malawi the feeling that the world was paying attention to their plight, that they weren’t going unnoticed, and that I was standing with them to help fight this terrible HIV epidemic.
Dr. Linda Austin: What do you feel you learned from that experience? I’m sure you learned many things, but were there any big surprises for you?
Dr. Caroline Thiedke: I learned that I could cope under circumstances that were different than what I’m used to here. We didn’t have nearly the resources, obviously, that we have here. We had very few blood tests that we could do in our hospital. We had only basic x-rays. We had ultrasound. But some of the things that we take so for granted here weren’t available to us there. We didn’t have an EKG machine, which I think would just boggle the minds of most physicians and nurses, and healthcare providers in the U.S.; to think that there wasn’t an EKG machine in our whole hospital. We didn’t have the ability to do potassiums. We didn’t have the ability to do various kinds of cultures.
But I learned that I could provide quality medicine without those sorts of techniques. So, I learned that about myself. I learned that I could get along with others, from many different cultures. One of the things that was the most fun about my six months was that I was working with people from lots of different countries. At various times, in the six months, we had people from eleven different countries on our team: people from Canada, France, Italy, Belgium, Iran, Sri Lanka, Kenya, the Congo. So, I learned that I could enjoy being with people from other cultures, and learn from them.
Dr. Linda Austin: Do you ever anticipate doing another stint with Doctors Without Borders?
Dr. Carolina Thiedke: I certainly would like to. That’s a question that they ask everybody when they finish up a mission, because they want to know, you know, how soon they can reassign them to somewhere else. I said that I would like to. It was a wonderful experience for me. I don’t foresee doing it in 2008, although I have been missing Malawi very much recently and thinking, well, maybe I should call those people again and let them know that I’m interested in doing a mission. But I don’t think that’s likely in 2008; but maybe beyond that.
Dr. Linda Austin: I’m sure that some folks listening to this may be thinking about this kind of experience for themselves and just wondering about the practical aspects of it. Do you earn a salary during that time?
Dr. Caroline Thiedke: Yes, you do. And I’m so glad you asked me that question. I think that Doctors Without Borders; of course, I’m biased, you know, my admiration for them is even greater, now that I’ve worked with them, than it was before. I just think they’re a highly professional, high quality organization. My travel expenses from Charleston all the way to Malawi and back were paid by Doctors Without Borders. I had a monthly salary, which was deposited in a bank account here in the U.S. Now, it was a lot less than what I made here. Although my understanding is, as people do more and more missions, that the salary increases and can become closely commensurate with what people might make back home.
In addition to the salary, we all got what was called per diem. So, each month, we would get a good sum in the local currency that we used to buy food, or if, you know, people wanted to go into town on the weekends and shop or go out to eat, or when people took a vacation, they would use that per diem.
The other thing that your question reminds me that I want to say is that, you know, the name is somewhat deceptive. Far more people volunteer with Doctors Without Borders who are not doctors. In fact, probably only one out of every five volunteers is actually a doctor. They use nurses, lab techs. We had a psychologist on our team. They have administrative people, accounting people. We had a mechanic on our team, a guy who came from England, who came to service our fleet of Land Rovers. We had logistical people. So, there’s a wide variety of job skills that really fit within what they can use for Doctors Without Borders.
Dr. Linda Austin: It sounds like it’s a fantastic opportunity. Does one get to choose a country, or continent, or do you just apply and go wherever they need you?
Dr. Caroline Thiedke: You know, for first missions, you really don’t have the ability to choose. Now, you can turn down a mission if they offer you a mission that, for whatever reason, doesn’t seem right to you. Maybe you don’t feel that it’s the right fit in terms of skills they’re asking that you have. Or, if you’re concerned that it’s an area that’s too unstable for your liking, you can turn down a mission. And they will offer you another one. But you can’t really choose.
Now, I will say, to some extent, whether people speak a foreign language or not, say if they speak French, or Spanish, may have some determination in where they get assigned. I think, again, for people who volunteer more than one time, I think as you spend more time in the organization, you probably do have a little bit more ability to choose where you want to go.
Dr. Linda Austin: Dr. Thiedke, thanks so much for telling us about this very extraordinary experience that you had.
Dr. Caroline Thiedke: Well, it was my pleasure, Dr. Austin, and I appreciate the opportunity to talk about Doctors Without Borders.
Dr. Linda Austin: Thanks so much.
Dr. Caroline Thiedke: Bye-bye.
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