As part of the Migrant Health Series, I interviewed Dr Conor Kenny who worked as the doctor on the Medecins Sans Frontieres (MSF) rescue missions in the Mediterranean. We met at a humanitarian and aid workers meet up after I got back to London and I was really keen to share his three-and-a-half months experience saving people, who had made that perilous journey for a better life, from the Mediterranean. His experience is also recorded on the MSF podcast ‘Everyday emergencies’. Click here to listen to the episode. Following from his MSF missions, he has now started his GP ST1, very randomly at my old VTS at Whipps Cross Hospital.
So why, after all his field missions, did he choose GP? He has a clear plan for a future in humanitarian medicine around which his career choices are based. “GP is perfect because, from the experiences that I have had with MSF, GP covers such a broad area, ranging from women’s health, to mental health to paediatrics and everything in between. I felt that GP training would be perfect for the contexts one might find yourself in. You have to adapt to so many different scenarios and you also don’t have any clinical investigations as well. You’re very much dependent on your clinical skills and your clinical reasoning and your history of course. And the flexibility of GP is key. Once you qualify that being able to take time off to go back into the field.”
But why a career in humanitarian medicine? “For me I guess it ticks so many boxes. I feel that our job is an absolute privilege and with a privilege like that there is a certain obligation, within reason, to use your skills – it’s not like any other degree – to use your skills in an environment where they are badly needed. I recognise that I am seriously lucky to be in the position that I am in. I also just love meeting different people, different cultures, people with different opinions to me. It makes me better. It gives me a better insight to the world. I love the teamwork aspect. There is a certain adrenaline aspect to it as well which I enjoy. Getting through some sh*tty situations and figuring out plans and working with a team to work it out. That’s it really.”
During the refugee crisis and even now, the hardest part for me to really comprehend is the desperation where an uncertain journey across the Mediterranean is the only remaining viable choice. I know I have always been risk-averse but would I do this journey if I had to? When it costs thousands of dollars to cross and the Russian roulette of a journey means you have to accept the possibility of death before departure, I cannot imagine how dark one’s situation has to be for this to be ok.
“Many of them that we rescued didn’t think that they would survive. They can’t believe that they had just survived a more hazardous journey through the Sahara, Libya – often in slave markets and milita-run detention centres. You can almost see it on their face the dawning of their life has just begun. They had escaped absolute hell and God knows what would face them over the next couple of months and years but as long as they are out of that hell now, the relief is huge.”
“There was a lot of people [that we rescued] from Central and Sub-Saharan Africa, from Nigeria, quite a lot from South Sudan, Guinea, West Africa, Senegal, Ivory Coast. Quite a lot of Bangladeshis because the migrant work force in Libya resulted in a significant Bangladeshi population who were then forced to escape. So many of them had their passports stolen so they had to use these boats to get out of Libya. There were many North Africans, Syrian refugees, a small number of Moroccans. But the majority from the time that I was there were Nigerian but, in the year gone by, however, they would have been Eritrean.”
There’s a part of his podcast that really captivated me. I wonder what it must feel like to witness the depth of the emotion of survival that crosses several cultural boundaries. Wherever we are from, happiness is happiness, grief is grief, and fear is fear. “It was probably my most favourite part of the boat because the beauty of watching cultural fusion is incredible. So watching Bangladeshi men sing with Nigerian women while these Ghanaian boys would be playing the drums. And various local dances. Absolutely incredible. Especially the day before we would reach the port of safety – there would be such elation – so happy to be alive. There would be a massive party every rescue without failure. It was remarkable that despite the many rescues I was involved in their expressions of elation would happen all at the same time and being able to watch this. To take five minutes out of my clinic to watch this made me think this is so worthwhile. It’s so beautiful. Sadly however, these reactions of elation would be preceded by sadness and fear and in port feelings of anxiety – the fear of the unknown, the fear of what lay ahead”
“The boat that I was working on was called Aquarius and on that boat there were two nurses and a midwife, a logistican, a cultural mediator/a translator, a comms officer, a project co-ordinator and a couple of volunteers as part of the mission. There were 12 rescuers, who were a separate organisation although we all worked together. In the medical clinic, we had everything: we had ventilators; we could intubate; we had defibs, IV access, IV fluids; and then a whole host of medication for the population that we were rescuing.”
“The important thing about working in that environment is that teamwork is so crucial and communication and when you’re working in an international team, outside the NHS, it’s definitely more difficult. It’s a total different dynamic and you very much have to adapt your ways.”
“Rotations were every three weeks. So even though I was out there for three-and-a-half months, the rescue team would change every three to six weeks. So every three weeks, I would be in port for two days, then sail to the Central Mediterranean where we would usually undertake three rescues. But even on your days off you’re still always on because you have to restock the ship, restock the clinic, training the team in basic life support , induction, all this kind of stuff. It doesn’t really stop.”
“From a technical skill point of view I think what was challenging was just the sheer volume of the number of people we had to treat. For example, we did a rescue of up to a thousand people. You would have a lot of sick people and how we identify these sick people was tricky so you would have to triage and re-triage. This was definitely something that you had to make up as you go along in terms of developing a strategy so that you don’t miss anyone. You’re always searching.”
What I find really interesting about a lot of my interview series is the matter-of-factness that these doctors talk about their missions, like Luke during his Ebola mission. Conor obviously would have seen some pretty dark atrocities on his mission – from treating victims of sexual violence, to fishing out corpses out of the sea, to listening to stories of the darker side of humanity. Further to that, it sounds like there were times when Conor’s team would have to face their own mortality whilst supposedly on a rescue mission. “[We would be rescuing] anything between 600-1000 [per mission] and our boat would carry 450 so we were always overfilled. It was totally not safe and there’s no bravado about that when you find yourself in that kind of scenario. If there was a storm, we would have sunk basically. No one takes any pride in that. Obviously it’s just survival. We did that just because we simply don’t have any other option. We couldn’t leave anyone behind. That’s the situation when you’re outside the NHS Health and Safety.”
The conditions sound brutal and it’s unsurprising that the missions are kept short to a few months. “As the only doctor in charge, you try and grab whatever sleep you can but the reality is that you’re always on-call and you can never relax until the last person leaves that boat.”
Whilst I’m talking to Conor about his experiences, I keep coming back to Roger Neighbour’s concept of “house-keeping” – the measures taken to ensure that the doctor stays in good shape for the next patient. I forget that Conor is only weeks into his ST1 but he seems to get it when I talk to him about this concept. “Personal housekeeping? It’s so important. As a medic you bear a lot of the responsibility, you become absolutely exhausted.”
“There was one at night it was quite choppy seas and there was a couple of cardiac arrests and I was out in another boat with a patient who was peri-arrest and to survive that is to realise that there is only so much that you can do.”
“I will never forget, a particularly hard rescue that we had, we recovered a couple of dead bodies. I remember I just wanted to run, we only had 45 minutes in port before we could be escorted by the port pilot to go back out. And I remember for those 45 minutes, I just needed more time to myself. Just to relax. I just ran for the hills as hard and fast as I could. I then found a few cans of coca-cola and then just sat in my room. Then I went straight back into trainings and rescue the next day.”
Being able to look after yourself is essential in primary care and I’m starting to understand that the consultation skills we learn in GP are also relevant to the field. “You really need your boundaries which is so key for self-preservation. If you cannot preserve yourself there’s no point. I would give everything that I can of myself to, one, the beneficiaries and, two, to my team in my leadership role- after all you need a well-functioning team to be able to give the medical care. Specifically for the beneficiaries I would try to ensure that they get access to all the support organisations waiting for them on land – for example mental health support or support for sexual violence. However, there is a line in how far I can push this and recognising this is an important step.” Seeing house-keeping in the context of an intense humanitarian mission makes me realise that learning to look after yourself is not selfish nor is it a weakness. “I guess self-preservation for me is that I need to sleep. I need to be able to eat and sleep and try to keep fresh or else you are doing the people you rescue a disservice.“
One of the things that I have also noticed in these interview series is how much everyone self-reflects. Is it because we are faced with such harsh realities and ethical dilemmas that we need to spend a lot of time processing this all? “I am still on a bit of a journey trying to do that. After my first mission, I took a couple of weeks off and went on holiday to Sri Lanka. It wasn’t very fun. I wasn’t ready. It was so hard to wind down. So this time I went straight into clinical practice. I took a week off and then went back into hospital . I had to delete twitter and FB for a while as it would always come up on my feed about various rescues or people dying and that was quite galling. I mean when I was there we rescued 4500 people but in the same time frame 1200 people died. So it didn’t feel like much of a success.”
“I did that [work in a hospital] for a month and then I was ready to chill out and go on holiday. Ironically, for a humanitarian, I prefer structure and routine. I prefer to be able to get up at seven every day rather than having to stay up for four to five days and try to get sleep where I can.”
“I think a huge amount of self-reflection, to know what kind of person you are what makes you tick. Everyone has their weak spots – I can definitely recognise mine – and I would manage that as best you can. You have to really know who you are.”
So, as usual, I ask him what advice he would give to anyone who is interesting in doing what he had done. “I think life experience is key. It is so crucial. You have to recognise that, within teams, you’re very much with non-medical staff. I hadn’t seen a doctor for months when I was on the boat. The point is that you need to be out of your hospital bubble and be comfortable with that. So yeah, I would recommend if you do get the chance to volunteer on a small scale with social groups, thats really key and then build up your experience from there. In terms of diplomas, Tropical Medicine was very useful, you can never get enough experience from A&E and working in acute situations.”
“With humanitarian medicine, in general, you need to be part of a group or a mission that does match your values whatever they may be. I’m not the one to say if someone’s values are better or worse, values are personal and drive behaviour. But whatever values you have, you have to find the context and an organisation that matches them. If you don’t do that, you’re probably in for a very difficult time. With the boat mission, like I say, there is such debate around the issue and you find yourself in such intense environments – lots of life and death situations – and you have to be really confident that you’re doing the right thing. So if you’re going to, in inverted commas, save the world without being confident of your conviction, it’s going to be hard. However, on a more positive note, having worked with and observed many GP’s in the field, they do possess a unique and broad skill set adaptable to a significant amount of environments which make them deeply valuable members or leaders of medical teams.”
Dr Conor Kelly took part in the Aquarius boat rescue mission with MSF and is currently in his ST1 at Whipps Cross Hospital.