• What aligned most with my expectations was going to hard-to-reach places and helping people in extremely dire circumstances
• The fact that MSF has been able to globalize a group of clinicians and other support staff to provide the help needed to less fortunate countries is amazing
• It was an honour to be part of an organisation that has worked for more than 50 years in the medical humanitarian sphere; their ability to create something out of nothing is awesome
• I also loved being able to be part of different cultures, to help people in need, and to be part of their journeys

• The most challenging aspect of the trip was witnessing first-hand the reality of war and the dark side of humanity beyond the imagined notion we have of war through the lens of media
• In the trauma hospital in Yemen we exclusively treated patients from the battlefields and other vulnerable civilians including women and children injured as a result of the Civil War which has been ongoing for over the past 7 years in Yemen
• Working in an extremely resource-limited setting posed a significant challenge – we had 7 ICU beds in a hospital with hundreds of COVID-19 patients and a city of almost 2 million people
• Coming to terms with this disparity between the way people live their lives in places like Yemen compared to war-free and resource-rich places such as Sydney was confronting
• Trying to help as many people as you can when you have limited access to oxygen, PPE, drugs, and other treatments is extremely difficult and at times can invoke a sense of helplessness

• If I were to say I didn’t feel unsafe at any point, that would be a lie – there were moments where we were in quite dangerous situations; in fact, my mission in Yemen ended because of a terrorist threat
• There is definitely an element of risk that you need to accept when you decide to work with MSF, and we are briefed on this quite extensively even before joining or going to the field
• However, MSF as a whole takes security extremely seriously and we have security advisors whose entire aim is to try to reduce this anxiety we may have about our own safety as much as they can

• We all deal with processing trauma in different ways based on our personalities
• Personally, I dealt with this trauma of constantly being surrounded by death and suffering very poorly, at the expense of my own mental and physical health
• I lost 10kg in 3 months in Yemen, I experienced sleep deprivation, and beyond that, I suffered burnout for the first time in my career and life
• I felt this profound sense of depersonalization and inability to feel anything, especially towards the end of my last few weeks in Yemen
• I don’t want to get to that place ever again, and a big lesson that I have learnt and try to pass onto my junior colleagues is if you ever feel yourself losing your humanity, take your time to pause, re-evaluate and recover as a person

• Interestingly Iraq was relatively more resource-rich than Yemen and therefore had a much better infrastructure
• The patient population was also of a higher socio-economic background, were relatively well educated and a number of them could speak English
• Doctors working in Iraq also had a higher level of experience – many were trained in anaesthesia and surgery
• This is all likely related to the relative geo-political stability that Iraq has achieved in the last few years, which reinforces the importance of good leadership and governance in ensuring a well-functioning healthcare

• Critical care specialties (ICU, ED, anaesthetics), paediatrics, and surgical specialties are all highly valued specialties

• Technically, MSF is willing to recruit any doctor who is PGY2 and above
• However, it may be more valuable applying when you are very senior (i.e. towards the end of training or when you are qualified as a specialist) as this is likely when you will be most valued and have most the impact

• MSF recruit throughout the year – there is no specific recruitment period
• The application process is long – it can take up to a year from time of application to deployment
• For Dr Musa, his period from application to deployment was 6 months; likely due to his ICU profile
• The application form is completed and submitted online – this may take around 6 weeks to 2 months to process
• A 2-hour long interview then takes place – it is a one-on-one interview and reasonably informal in nature, like a long chat with multiple questions
• Finally, the period from being accepted after the interview and the wait until deployment can take up to one year

• It depends on the college – at this stage not many colleges will accredit the time spent working with MSF
• For example, it currently is not possible to accredit time working with MSF as ICU training
• However, it does count as training towards fellowship for ED, paediatrics, and potentially Obstetrics & Gynaecology

• Yes – around $15,000 a month
• In addition, all costs involved in deployment (travel, insurance, visas, accommodation, meals, etc.) are covered

• Remember that there is more to life than medicine
• Prior to going to Yemen, I had this mentality that I was going to save and help everyone – this mentality can be dangerous as it often comes at the expense of your own safety and wellbeing
• I am seeing a bit of that anxiety now with my junior colleagues – my first-year medical students have expressed anxieties about the competitiveness of certain specialties and whether they require PHDs
• My message to junior doctors is that whatever route you take, things will work out – it’s not a race or a competition so take your time and go at your own healthy pace
• As important as the work we are doing is, there are other considerations including family, friends, and a life outside medicine
• One lesson my mentor taught me as an SRMO was: “to do the work well you need to balance everything you’re seeing and doing with all the beauty in the world”
• Sometimes we get tunnel vision and miss the moments which make life so meaningful
• We often feel a pressure to reach the end of this tunnel, but in reality there is no actual finish line – you can get on this train forever, so taking time off the training conveyer belt is valuable
• I encourage people to take time off training, not necessarily to do MSF, but to explore other things in life – the lessons you will learn will be valuable and eye-opening

• My hope is to continue contributing to MSF and to be able to combine humanitarian medicine with ICU work
• I am also currently completing a diploma of palliative care which I believe is an under-valued and misunderstood specialty – rather than other medical specialties which may be overly technical, palliative care views patients as subjects with emotions, hopes, dreams, family, friends; and I hope to carry this human aspect of caring for others with me in the work I continue to do in the future
• I am heavily invested in global health and in terms of what the long-term future may look like, I may be heading more towards the governance aspect of MSD rather than doing the fieldwork itself
• I hope to inspire others to do more humanitarian medicine and am happy to be contacted if people are interested in this work

• We all have the potential and responsibility to give back and to contribute in a meaningful way to those who are more vulnerable and less fortunate than ourselves
• MSF is just one example of the multiple ways in which we can involve ourselves in humanitarian medicine
• Geo-political and economic stability are crucial social determinants of health
• Witnessing trauma and death can lead to depersonalisation and burn-out, which may require a period of taking a break from medicine to reflect and recover as a doctor
• There is no prize for finishing training and becoming a consultant early – work at your own healthy and fulfilling pace rather than racing to a perceived finish line
• As important as the job is, it is not so important that you should ever lose yourself to it completely

Where the light enters: Reflections on the fight against COVID-19 in war-torn Yemen, by Dr Khairil Musa (15 September 2021).

https://www.croakey.org/where-the-light-enters-reflections-on-the-fight-against-covid-19-in-war-torn-yemen/