What do we sacrifice in the name of global health? – Interview with Dr Berit Hansen

London School of Tropical Medicine are doing a free online course on Health in Humanitarian crises via Futurelearn. It expires on the 8th October so get your skates on!

Interview with Dr Berit Hansen, GP trainee, Copenhagen

When we qualify as GPs, we tend to be in our late 20s and early 30s. The world is suddenly our oyster but then we’re hit with societal and personal pressures of settling down, buying a house and having children. So, is “around-30” a good time to go galavanting around the world or should we be seeking opportunities nearer home? Should we be buying our houses, finding life partners and thinking about having children before worry sets in that nature will have its way? Now, I’m not saying that these are incompatible with global health work any more than they are incompatible with a career in general but these are normal pressures that women (and perhaps men too) face in the modern world.

I interviewed Dr Berit Hansen, a GP trainee from Copenhagen, because I originally wanted to delve into her experiences of the three Medicins Sans Frontieres (MSF) missions she had completed but the conversation took a different turn that was as uncomfortable as it was fascinating. One of the things I love about Berit is her frank openness – I don’t know if this is cultural but I’ve known her to voice thoughts that I’m sure most of us are not brave enough to state out loud.

The backdrop is three MSF missions – six months providing basic healthcare in the Central African Republic, six months in a clinic in Guinea treating Ebola sequelae and two months delivering a yellow fever vaccine programme in the Congo.“I always wanted to work for MSF, it was a personal dream. With MSF, I felt that I could use all the skills that I had learnt and see things that I couldn’t see in Denmark and I just love the way the organisation works. In many ways, I got it into my head that I wanted to do it. And everyone said “Don’t do it, it’s too dangerous. You’re a blonde girl” so that just made me want to do it more”.

My impression of MSF is that they are edgy – an organisation who will go where no one else is willing to go. Truly sans frontieres. Weren’t you afraid of safety? “You get this paper where you have to answer ‘are you willing to go anywhere for a mission?’ and ‘is there anywhere you don’t want to go?’ I was so eager to write ‘I don’t want to go to…’ it was Afghanistan at the time. Probably Central African Republic. They said that if you put that, you may go down the priority list because they need people with availability. What changed my mind is when they said ‘People often say, before they go on a mission, security is the only thing that they think about but once they arrive they forget about it. The minute you feel insecure, you can go home.’ So then they offered me Central African Republic and I thought if I had overestimated myself then I can always go back.”

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Whilst we were chatting about her missions, we talked about why GP is a great speciality for field missions. “I think GPs are really good at being flexible and taking on the agenda of the patient in a setting where you don’t know what you’re going to meet.” The World Health Organisation (WHO) discuss that the reason why primary care is fundamental in the provision of healthcare is because we adjust to population needs. “And communication – being able to give the right information, being able to ask the right questions – that is a skill that we learn in general practice. I think general practitioners are perfect in many settings. And you can put us anywhere and we’re not scared. That is not something every doctor can do. As GPs we’re used to uncertainty so we’re not scared of saying ‘I don’t know.'” And why should young GPs get involved? “Curiosity is a quality of a young GP as well as eagerness to figure out how to help.”

What do you think you learnt with MSF that you didn’t learn in Denmark? “The most important thing that I learnt was people management, like managing new employees and the way that you communicate, how are you a good boss, what does it mean to be a good leader? And then trying it in practice. I remember thinking ‘If i can do this, there’s a lot of other things that I can do'”.

When Berit returned from her missions and interviewed for several posts, she was passed over for other doctors with research experience which got her thinking about how other people viewed her humanitarian work. “I spoke to a lot of my colleagues who felt that doing research was a way to get their foot in the door and they thought what I was doing was a waste of time. I remember how disappointed I got but also how surprised that people would look down on what I did.”

“I feel that some of the things that I have learnt, I would never have learnt in Denmark. I didn’t understand why research would be more important than the work that I did in my specialty. Our education is very square in that way I guess and we have to do 14 of this and 13 of that and then suddenly it becomes valid. How do we measure our knowledge and experience?” 

This is really resonating with me. I remember my arguments with my surgical deanery about why none of my operations (with a British consultant supervising) on my surgical camps were allowed to count in my logbook. One Head of Deanery said to me “off-the-record, we love what you’re trying to achieve, but on-the-record I have to tell you that you’re wasting your time.”

“If you felt that you have achieved something that you think is big for you I think I felt that they didn’t know anything I do. If you think this is boring or a waste of time then you don’t know what it’s about. It was weird hearing that and I started questioning ‘should I have stayed at home because I might have met someone? I might have a child now, I might have done a PhD. Is this a weird way of leading my life?’ and I started questioning my own choices.”

“When I came back to Denmark, without a place to stay. I had booked a little garage where I had kept all my stuff and I was living in this little sh*thole of a room with three 20-year-olds partying every day of the week and I was thinking ‘What the hell am I doing?’ and when I was trying to find an apartment and I had no money to put down as a deposit as I had spent every single penny on traveling.”

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I feel that there is a certain sacrifice when working in global health. Whilst colleagues are powering through their training and clocking up measurable experiences at home, it’s almost like we enter a world of Narnia. Even if we feel like we’ve spent an eternity away, we come back exactly where we left off. “And it annoys me that we have this pressure. It’s really annoying that there is this life at home that you miss out on because everyone is doing something totally different in their life that you feel is so much further than your own. I don’t know if you know that feeling of ‘oh my god, how am I ever going to…'”

I’m definitely hearing this. I’ve come back from nine months away and I’m struggling to rent a flat as I have no proof of income whilst my friends are putting down deposits for their first homes. It is this strange sensation – would I trade in all the valuable experiences I have had to plod down the trodden path? “You can start questioning or you can say that was my choice and I made the best out of it. This made me the person who I am today. I think I would have felt worse if I had not done it and thought why hadn’t I done it. At least I don’t have that. That was my dream.” 

“I’ve always done this calculation with my life where I have counted in years of fertility. To work for MSF, you have to have two years of work experience before they will send you somewhere. So I thought ‘I will finish medical training and then I have to work… then I have to do a few missions. I just calculated that I would be super old.’ In this era of social media, we are inundated with projections of confidence and strength, so her frankness about her vulnerability is refreshing. Although she is very happily in a relationship now, how was she to know this at the time?

“The moment I felt most free is when I was on these missions. Because I was surrounded by people who were as lost in these pressured societies as I was but we just gathered together and we didn’t talk about it. It was like a dream. Let’s climb this mountain on the weekend, explore this area of town, it was more about we’re here right now and let’s do what we can whilst we’re here. Not being surrounded by people talking about society pressure, not having these common themes. My grandparents’ generation think I’m the weirdest person alive not having children yet. And not hearing that is so nice. The best thing to do when you feel lost or pressured is to go away for a while. That’s where you can breathe and there are other people that don’t want to do it that way but it’s just that I’m surrounded by people who do.”

“I have met so many different people on these missions. I have seen everything. I have seen people in relationships where the guy or the girl has stayed at home; I have seen couples on mission; I have seen singles; I have seen infidelity; I have seen the most beautiful things happen. It is so individual. If you have a well-functioning relationship then you can definitely have a relationship whilst on mission. Is it difficult? Definitely. Especially if it is in an area that is dangerous. Nothing is impossible.”

Now I have no answers for anyone who is considering going on a field mission and is facing that wall of insecurity and societal expectations. The whole point of this post was to show that we have all been there and faced that uncertainty. Our situations are all highly individual and there is no one-size-fits-all. Being able to examine what makes us who we are and why we are pursuing a career in global health will go some way in giving us the answer. But what we do say is don’t hold yourself back if all you’re worried about is the potential of missing out.

“I would not say that it’s not important not to have kids if that is something that is a big part of you. But if you really want to do it [work for MSF or go on field mission], do it. Because not only would it give you confidence for the work you do because it’s super interesting and you get so much from the work that you’re doing and the people you meet – that’s amazing. But give yourself the break to ask yourself is this really something that I want. Get that space from everyone around you and ask yourself do I really want to have a kid and learn to build up the guts to say I’m not going to wait for Mr Perfect. It’s just sometimes difficult to make a choice when you feel pressured in doing something. Or if someone thinks that I’m too old to do this then it’s bullsh*t – don’t think that a mission with MSF is going to stop you from having a child. Even though you are 36 – MSF is not going to be the thing that stops you. My mum said to me ‘You don’t want to go on a mission because of what? So instead of going, you’re going to sit on the pavement with a big sign saying “marry me”?! Don’t wait for it. This is something you’ve always wanted and if it comes it will come’ and I thought ‘yeah she’s right’. The norm does not always bring you happiness.”

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This is much food for thought and I’ve never had someone articulate this in the way Berit has done. This has sparked an interesting conversation thread within the Junior International Committee (JIC) about balancing work and life. Some of the women in the team have managed to have young children whilst pursuing a career in global health so this is something that I might be interviewing them about (press ‘like’ for this article and I’ll definitely do it!). So, whilst I’m left musing, I’m going to leave you with the wise words of Sheryl Sandberg, CEO of Facebook, from her book “Lean in”:

“If I had to embrace a definition of success, it would be that success is making the best choices we can and accepting them”

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