Dr. Deane Marchbein
Marchbein was recently elected president of the board of directors for Doctors Without Borders USA. The international organization provides health care and medical training in war torn and impoverished countries. Also known by its French name, Medecins San Frontieres (MSF), it won the 1999 Nobel Peace Prize. Marchbein, an anesthesiologist at Cambridge Health Alliance, affiliated with Massachusetts General Hospital, joined Doctors Without Borders in 2006.
‘MSF makes a huge effort to mitigate the risk and keep their people safe. But it’s kind of inherent in the places where we work; you can’t always keep people safe.’
Q. What was your first mission?
A. In January of 2006, I went to the Ivory Coast. It was in the middle of a civil war, and I was working behind rebel lines. The most dangerous part of that mission was the six-hour drive from the airport to the government-run hospital. It had been abandoned because it was behind enemy lines. I was the sole anesthesiologist running the operating room, the recovery room, and the so-called intensive care unit.
Q. What sorts of cases did you see?
A. They didn’t have the concept of pediatric wards, so children with surgical problems were with the adults. I saw a lot of children burned in fires because they cook over open fires. They were getting infected because they were with the general patient population. I asked the hospital manager for some mattresses, and we started a burn unit in one corner of the ICU. If you identified a problem and a solution, it was pretty easy to implement. It’s pretty exciting to be in the field.
Q. It can also be dangerous. MSF workers have been arrested, killed, and kidnapped. Some have contracted the diseases they are fighting.
A. Two of our colleagues were killed in Kenya six months ago. Two of our Spanish colleagues were kidnapped in Somalia and have been held for 7½ months. MSF makes a huge effort to mitigate the risk and keep their people safe. But it’s kind of inherent in the places where we work; you can’t always keep people safe.
Q. Tell me about a dangerous spot where you have worked.
A. I spent this winter in Lebanon, working on getting medical supplies into Syria. Health facilities, doctors, and nurses were targeted. Since we were not sure we could keep the team safe, we had to abandon the idea of putting them in the field. So I Skyped with medical counterparts to understand what they needed and I taught a trauma course in Lebanon for those who might be going to Syria. And we were finding ways to get medical supplies in there.
Q. How did you do that?
A. Basically it’s about consorting with smugglers. There are thousands of years’ worth of well-worn smuggling routes from bordering countries. So instead of flatscreen TVs, they were smuggling in medical supplies.
Q. How often do you go on missions?
A. I do a mission or two every year. I take an unpaid leave of absence. My employer has been extraordinary flexible and generous in accommodating me. As an anesthesiologist, my missions are relatively short. I do six to eight weeks in the field.
Q. What are your duties as president?
A. My responsibility is to be the public representative, talking to professional societies, the media, donors, helping recruit people to work for the organization. For me, the work I do in the field informs my work on the board. More than going on a visit as a VIP, being a foot soldier in the field gives me a grass-roots understanding of what we’re doing.
Q. Given the sometimes dangerous nature of the work, do you have trouble recruiting?
A. A lot of people would love to go with us but they’re not prepared to make the time commitment one needs to make. For a general doctor, it’s a 6-to-12-month commitment, which is huge. I can’t tell you how many doctors say, “I’d love to go, but why won’t they take me for two weeks?” The continuity of the project requires a longer commitment.
Q. Do people get paid?
A. For the first 12 months, they’re paid at a fairly low salary to encourage volunteerism. After you’ve worked with them for a year, the salary goes up, but it’s never anywhere close to the salary someone would make in the US. The majority of the people I work with in the field are locally hired people paid by MSF. For every international staffer, there are 10 local staff.
Q. Tell me about a patient you particularly remember.
A. There’s one from every year. The really amazing thing about MSF, and what keeps me coming back, is that I’ve felt on every mission that there is always a person or group of people whose lives were saved or improved because of my particular skills.