I am Arjan Hehenkamp, I’m a General Director with medical emergency aid organization Médecins Sans Frontières/Doctors Without Borders (MSF). We work in crises such as The Philippines. AMA on our work.

First of all, thank you so much for all the work you do. You inspire a lot of people to follow in your footsteps, including me. My questions:

• When did you realize you would make an entire life out of MSF work?

• Do you ever think about the “normal life” you may have had just staying at home and donating money to MSF?

• How do volunteers who are frequently traveling find interpersonal intimacy?

• What is the worst thing about humanitarian work that we’d never guess?

• As a nurse finishing school in a few months, what can I do to make myself a realistic candidate while I am waiting for the 2 year experience minimum?

Thanks so much!

/r/doctorswithoutborders

edit: Since this is getting upvotes, I encourage those interested to watch "Living in Emergency" and "Access to the Danger Zone". Books include "Hope in Hell", "An Imperfect Offering", and "Writing on the Edge"

My life is normal, MSF is mainstreamed into my who life. I cannot imagine leaving MSF, frankly.

With MSF, teams live, work and sometimes fight or make-out together. That is part of the MSF experience. Some love it, some cannot cope. It makes for very strong bonds!

To make yourself available you need to finish, get experience, have great motivation and then apply and go out!

Arjan

I did not realise it immediately, I went into MSF and never looked back

Hi!

I just finished reading Peter Redfield's Life in Crisis: The Ethical Journey of Doctors Without Borders and was really interested in some of the ethical dilemmas he addressed. Have you read the book? What has the reaction been within the organization?

No I am afriad I have not had the time. What did you learn about MSF that you think is importnat?

Hello Arjan! Thank you for doing this, a couple questions for ya!

-What is the current state of projects of MSF in Somalia? What is the biggest challenge in Somalia regarding humanitarian aid?

-What is the biggest challenge you've faced during your position as a General Director of MSF Holland?

Also, guys, please visit us at /r/doctorswithoutborders!

MSF has left Somalia recently. I was one of my hardest decisions ever, the same for many of my colleagues who have worked there. It is still a major crisis but we experienced so many major security incidents, and the authorities were either unable or unwilling to prevent or address these incidents, that we felt forced to depart. BIG BIG impact for the population, major heartache for me and many others in MSF still. Two countries I want to return to still as MSF General Director: North Sudan and Somalia.

Biggest challenge is to ensure we can remain present and effective in some of these very dangerous and complex countries, like Afghanistan, Pakistan, Syria and so on

Hey Arjan, I was hoping that you could tell us a bit about the personal effects of going from field to office and back. What do you find is the hardest part of both worlds?

Edit: Please everyone subscribe to our SUB r/doctorswithoutborders/

The hard part is to live in both of those worlds continuously. MSF is in the system and in the genes, and it gets hard to leave it be for a while. I know people who have left MSF and have felt relieved from that continuous pressure you put onto yourself. But then they miss it and they come back or want to come back.

What are some of the most incredible stories you have seen firsthand?

I recently was in Central African republic and saw 30,000 people cramped onto a small space on the church compound. not daring to return to their houses even if a few hundred meters away. They were THAT scared by the violence. That was impressive!

Are they really safer on church grounds, i.e. will people participating in violence leave them alone there?

They believe they are. Being close to one another, rather than living separatelty in their own houses, helps. The security of the crowd. Having said that, there are also many thousands who fled into the bush. And we have difficulties finding/accessing them there, and they us!

I love the work you guys do! Whats the most surprising thing you found out about a country that disputed a preconceived notion you had about it before going there? I'm really curious about the real world vs. what the media ingrains us with.

There is always a dominant narrative which fits our own perceptions and realities. It is quite interesting, if you sit down with some of the radical groups in today's conflicts, that they have a very logic narrative of the world too -- which is persuasive but is completely contradictory to your own understanding. So the need is for dialogue, everywhere!

Hi there! I have always had an interest in working with MSF one day once I finish my medical training, and had a couple questions for you..

• How does the current MSF involvment in the Philippines compare to other regions you've worked in? Is there a large difference in involvment in short term relief efforts as compared to the longer missions you've been on?
• Of all the regions you've worked, where do you think you were able to have the biggest impact?

Thanks for doing this AMA!

In the Philippines, it is in fact a 'normal' disaster. It hits hard, causes massive destruction. We mobilise immediately, mount a major and a quick response, and then it we will prbably be able to leave relatively quickly as other organisations step in and the government takes responsibility.

My best impact was in South Sudan, where I was Head of Mission for four years. i have lost my heart to Sudan, some missions do that to you. I cried when we were thrown out of North Sudan (I should not say this on the internet, but it is true)

Hi Arjan. How do emerging actors, particularly those with names similar to MSF - Physicians Across Continents (working in Za'atari) etc - affect the perception of MSF programmes?

We are viligant to those, but then again we have to accept that the 'without border' concept work for many and hence we are only focusing that really have an impact on our identity or our programming. But we're always on the lookout, so watch out!

Thanks for all the work you do.

I’m curious regarding mental health illness and MSF. What are current policies and considerations on how to treat the mentally ill, especially those with long term mental health considerations. Any specific challenges with stigma and stereotype?

Mental health programming has become a big part of our work, since years now. It is normally integrated into our other medical interventions. More recently we have tried to integrate psychiatry into our work too, working with normal doctors though asking them to treat those patients. Not easy, but these patients usually are not taken care of in the context in which we work!

Hi Arjan,

I am a Street Medic working in the U.S. and am in the beginning phases of creating a mobile health resource project.

My colleagues and I have worked in numerous disaster areas (Hurricane Katrina, the Haiti Earthquake, Hurricane Sandy, etc.) and have consistently been extremely disappointed with the "work" being done by both the American and the International Red Cross. They seem to be great at setting up tent cities (good for them!) but absolutely awful (and at times even harmful) at actually providing resources like food, clothing, or medical treatment.

What have your experiences with the Red Cross been like in your work? If you could change something about how the Red Cross operates, what would it be?

Red Cross is national, and ICRC is international. My experience is mostly with the latter. And they are close to us and I have the utmost respect for them, more so than for most other organisations. But the national Red Crosses come under national organisations and that is a different kettle of fish depedning on the country

What progress has there been on MSF's clinical trial of a new drug combination for multiple drug-resistant tuberculosis (MDR-TB)?

Thanks for your time!

We are in the set-up phase. We just heard that one of the new drugs has received regulatory approval. Which is great news. We still need to get agreement with the pharma companies for the use of the drugs and its data, and then it is time to start implementing. Complex processes, takes time.

Hi Dr. Hehenkamp, thank you for everything you do in MSF. As a medical student, I've been interested in doing work in Doctors without Borders, but would also like to be a family man back at home. So my question is, how long do you go on medical missions, and do you have much autonomy in regards to where you go/when you return?

Depends a bit, we tend to have shorter mission for medical specialists. But otherwise, the first mission should be 9 months. Average mission duration with us (in Amsterdam) is 7 months across functions and missions.

First time out you do not get a lot of choice, thereafter you do.

Hello. I am a student at an ivy league university studying Climatology. This year I am on medical leave due to severe anxiety and depression.

When I heard about the devastation in the Philippines I decided that I wanted to help. I emailed the philippine red cross and offered my services in whatever capacity they saw fit. They responded promptly that they would get back to me with deployment information as soon as they knew where they needed me.

My question is: if I have the choice between buying my own ticket to the philippines in order to help on-site for 6 weeks, versus donating the $1000 directly to the relief fund; which will help more?

I want to help, and I want to have a real impact, but at the same time I feel as though they have lots of physical laborers (I am not a doctor, or hold any special qualifications), and are probably more in need of financial resources. What are your thoughts?

Honestly, the money is probably more of a help. Your intention to help, though, for me is the most valuable. However that is done.

Thanks for the honest reply. I think I already knew the answer.

It's hard to imagine another time in my life where it would be this easy for me to drastically change my life on a moments notice. I have no commitments, no school, literally nothing holding me down here.

Would you recommend taking basic first aid/first responder courses before entering a situation like the Philippines?

Of course! Personal safety is key. But also you really have to think, what am I bringing? Am I a value added? Harsh questions but important.

Well, I dont know.

That's why I was asking here.

Your opinion is clear.

As long as you have a hard skills which is useful to an organisation, AND you are motivated, then you can work for a humaniotarian organisation. As for the skill, it depends on the organisation

What has been the biggest, most recurring healthcare crisis in BiH since the war?

Bosnia, you mean?

Had a friend who's parents worked for the WHO in Liberia in the 80s and 90s. Those guys were crazy to be there, but still, seems interesting that some people can be in the middle of a lawless warzone and do what they do.

Course, that friend went to visit his parents there in 1990 while the civil war was still ongoing, came back with the 1000 yard stare as if he'd visited hell itself and somehow managed to get back.

I suppose being to a place on earth where blood actually runs in the streets possibly turned him off to a medical career. Dunno.

Yes, it can be tough. But then again, in MSF you can actually do something to help -- and that in turn helps prevent you from feeling powerless and that (I believe) prevents trauma. But then I am no psychologist!

The /r/atheism community is currently doing our annual donation drive for MSF, thank you all so much for the work you do :)

1. What are some differences between what your organization does and similar organizations like the red cross?

2. What situation have you felt particularly proud over where you feel like MSF was able to help the most?

3. What kinds of bureaucratic hurdles to you encounter?

MSF is into DIRECT action, i.e. we do the work ourselves and we do not work through other organisations -- as many others do. We are also highly specialised in medical work and in crisis and conflict situations. We are, I think, also one of the most independent organisations around. We are probably closest to the ICRC in those respects.

I have been incredibly proud of what our teams have been able to do in Cwentral African Republic of late, but also last year in SOuth sUDAN when thousands came across the border hundry and thirsty with people being abandoned by the side of the road. Our team was there along the way, being in proximity with them and mobilising a large scale emergency. Sometimes we asre not just important, but existentially important to populations and patients. CAR and South Sudan were examples of that. It makes me deeply proud and privileged to work with MSf to be able to help people in such deep, dark times.

Also, our willingness to shoulder risk and try and find ways to work in the very very difficult context of Syria is really important.

MSF does a great job with shorter term projects like crisis management. Do you see longer term projects like building established residency programs or teaching hospitals on MSF's horizon?

Does MSF look to permanently and positively change a foreign country's medical infrastructure during its missions? What's most important to keep in mind in order to have a lasting impact?

Take AIDS and TB. We also want to change the way these diseases are recognised, managed and resourced -- and hence we are often also looking to change policy, protocol or introduce new technology or a new strategy (as with nutrition, plumpynut).

But we cannot do that everywhere. Sometimes we can only treat and be with patients. And in some situations that is already incredibly important. Even if these situations are a repeat of what happened a few years back.

So, if you want to change something: keep going until you drop!

How long is MSF planning on staying in the Philippines to provide medical support?

Probably 2-3 months max for most of it, scaling down significantly from where we are today (over 200 international staff) and then remaining with a smaller presence. But it also depends on what other actors will do.

How do the staff of MSF deal mentally and emotionally with the many traumatizing things you must see everyday? Have you found it easier to cope with or do you think you have to be a particular type of person to start with in able to do this type of work? Much respect, gratitude and awe for what you do.

Emotional stability and stress resistance is key. But you can get lots of support from teams, too, and from the fact you are able to help and do something. In addition, we have internal capacities that support individuals after traumtaic experiences -- during missions as well as afterwards

a) Are there any MSF campaigns that Reddit can help out with? b) If there was one person that would make for a good spokesperson for MSF, who would it be?

This is my first time on Reddit. Up until a few days ago I did not have a clue (SORRY). So let me sleep on this after I have finished today.

On spokespeople, we usually want those to work in the field to speak for us -- that is the best way to ensure we speak from experience and the situations in which we work rather than as an 'organisation'. We do not normally ask celebrities to speak on our behalf. Of course, they are welcome to speak positively about us!!

What non-medical infrastructure is most important to your work? This could be physical (roads, running water) or something intangible like a strong community, anti-corruption policies, etc.

Integrity is a big challenge, as we work in some of the more difficult and corrupt places so we need to have strong policies and practices in place.

Otherwise, our logistics backbone is KEY -- without it we would not be able to mobilise so quickly or qork in such challenging conditions

Thank you so much for your work! I have been incredibly interested in working with MSF and helping out those in need.

1. What would you say is something that someone wishing to join MSF should have that cannot be taught or learned in school? (personality wise ect).

It is first about having a hard skill but then secondly it is mostly about the commitment, motivation and ability to take stress. The motivation is key!

Thank you so much for your work!

Many of us here on Reddit have learned from bad experiences and exposures to remain skeptical of many organizations soliciting donations for crisis victims. Far too often these "organizations" are just curve-toothed money leeches that give little-to-none of the donations to the victims and absorb funds into "administrative costs."

What organizations would you endorse for donations, and are there any well-known organizations you would advise us to be wary of?

Thanks!

Honestly, I cannot answetr that for you. I agree that not all organisations have have good ethics when it comes to fundrasing. But Each of you will have to make your own choice, based on your own research. Then it is a question of trust, too. I feel MSF deserves that trust, having shown it through our programmes but also when we call (as we did for the Tsunami) for a stop to the donations we are receiving when we believe we do not need more. There are other such organisations, too, for sure.

I know from interviewing Dr.Joanne Liu for her campaign that she spent the beginning of her career struggling to pay rent. She would sleep at friends houses when returning from a mission and just recently was able to "settle" down. How did you cope financially with your first missions?

Also, guys, please visit us at /r/doctorswithoutborders

Joanne was a doctor who has had to invest in her studies. This was less the case for me, being from Holland and studying anthropology. So not such an issue. But MSF is not a money-maker, that is for sure.

Hi! I wanted to know how the MSF feel about the political conflicts that you have to confront everyday and what has been until now the worst response you've had to the help you try to provide. When was the first time you denounced the injustices (violations of human rights) of a political regime? You do a wonderful work helping people, God bless you!

MSF is neutral and impartial. In order to work amidst chaos and unadulterated violence and sometimes evil, we have to discipline ourselves and not be judgemental. But we should ALWAYS describe a situation so that it is known, and SOMETIMES we denounce a situation, risking our presence and our help to populations. Such as we did in Rwanda, in Ethiopia, in North Korea and in other places.

MSF is known for taking a stance on human rights issues moreso than typical aid organizations like ICRC. I admire this about MSF

1. What factors influence your desire to take further action (like raising political awareness) about a conflict?

2. Is it easier to do your work as a physician when you have a strong opinion on an ongoing conflict, or is it easier to remain neutral and not think about it?

(edited for formatting)

That really depends. We are not a human rights organisation but do take strong positions on humanitarian situations or if we are blocked to do our work. Some believe this makes us non-neutral and stops us from doing our work in places like North Sudan. I believe it is one of our strongest traits as an organisation and we should never give it up. But easy it aint!

First off, I would like to say that MSF is a dream job of mine. You guys do amazing work for some of the neediest people and it makes me proud to know that people are out there who will dedicate their lives to this kind of thing.

My wife is on her way through nursing school now (and did Peace Corps with me). We have talked about doing something like MSF for a long time once she has some medical experience under her belt. I also have a wide range of experience working in developing countries doing WASH work.

• 3 years in the Philippines doing Water Sanitation as a Peace Corps Volunteer

• 5 years in the water industry in the US doing a wide range of field and desktop based water science.

• 5 years in the US doing mountain search and rescue (coping with bad weather and sicker people)

A few questions:

• Do you place couples together?

• Is experience as a working nurse enough to be useful to MSF?

• How can we make our application stronger?

• What are the range of lengths in assignment?

• Are you generally in one place for the duration of your assignment or is it a very transient thing?

• How quickly do you mobilize after a disaster?

Thanks again!!

We are probably the quickest to mboilise following a disater but neighbours and friends are by far the quickest in the first instance -- in ALL disasters.

We do place couples together, but it is a puzzle. Generally, you should be willing to go out for 6 months!

Making the application stronger requires for your wife to complete her studies, have work experience and then you are set!

What kind of technology issues plague you the most when out in the field? I work in a lot of different areas of tech, from general computing/networking to robotics, electronics and automation.

I make some smartphone enabled hardware devices and have always wondered about little medical devices, from an insulin meter/pump to diagnosis tools (i.e. tricorder) and how a smartphone can be used to improve the field experience of someone like yourself.

How are you using smartphone/tablets in the field now and what would you like to see done in future for field medical technology? What would be more helpful, a tool to take and analyze blood samples...or an app that can easily sort and store the data collected by such tools? What is the bigger hurdle there?

Personally, I feel that we are NOT on top of this at the moment. We do far too little with technology in our activities, yet this technology is part and parcel of our daily life back home. It is not easy, but this is something I want to change as General Director.

Apps, smart devides and miniature biomedical materials for instance.

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Contact any MSF office nearby you to find out what the possibilities are. We are, in spirit, volunteers still as MSF and so we like working with volunteers as part of the character of the organisation.

Thank you so much for the reply! I will definitely do that. I was also wondering, how do you work around issues like recognition of medical qualifications in different countries?

That is not easy. We have some data-bases that we can consult (don't ask me the details) but also we do not accept all medical qualifications. There is a need for a basic international or regulatory recognition of the diploma's.

How much do you interact with other organizations (such as engineers without borders)? Do you think more could be accomplished if these groups were unified and became professionals without borders?

We do not, really. These groups are set up independently from us and there are many of them. We're not part of the same family, and do not necessarily share the same values or mission. So we keep to the bothers and sisters we already have within MSF, and once in a while we make babies in South Africa and India where we set up new offices to recruit and raise funds, too.

How has the associative nature of MSF helped or hindered the organisation's work?

MSF in unique in that everyone who has worked for MSF also OWNS the organisations by becoming member of the association. And the association elects the Board, and the Board supervises the executive and holds it accountable. That is an incredibly valuable part of our organisation.

Sometimes iit is a pain, too, but then again I would not want any other organisational structure.

Hi Arjan, thanks again for doing this. Greatly appreciated.

My question is: Which of the many missions that MSF run do you wish recieved more attention from the media?

For example; MDR-TB and the treatment of it is a massive issue all over the world, but TV and traditional forms of media tend to ignore it in favour of more immediate or dramatic issues.

At the moment, CENTRAL AFRICAN REPUBLIC, without a doubt!

Second, is NORTH SUDAN, where people in Southern Blue Nile, Souther Kordofan and Darfur are heavily affected by conflict and violence and there is nearly NO access for humanitarian organisations.

Third, NORT KOREA and ERITREA, completely inaccessible with tyranical governments.

I have been making monthly donations to MSF (in Canada) for about two years now. Outside of just making donations and raising general awareness through social media, is there anything else that an "Average Joe" like myself can do to help? Do you ever look for volunteers who aren't medical professionals?

Yes, for sure. Look at our websites for job opportunities. Otherwise, if you cannot donate or work for MSF, care for those who are dispossessed or distressed in your community. It is the intention which is important

In Ben Goldacre's book Bad Science. He talks about Matthias Rath and other Aids denialists along with MSF being sued for bringing antiretroviral drugs to the country. How difficult do you find it to give medical aid to people when you are opposed not only by ignorance or misinformation but people inside the governments of the countries you try to help opposing what you do?

Finally thank you for the work you do. There are few organisations I admire as much as MSF and I donate to it when I can.

I would like to add this quote from the book.

" but also for the many other people he’s tried to sue, including Medecins Sans Frontieres and more. If you’re ever looking for a warning sign that you’re on the wrong side of an argument, suing Medecins Sans Frontieres is probably a pretty good clue."

This is part of the obstacles we face every single day, in many of the countries in which we work. It is our job to convince and to engage and to push and to pull, until we can effectively assist those that need our help. Most of the time, we manage. Sometimes we do not. Such as in part of Syria.

do i need to be a doctor to be a part of Doctors without borders? if so what sort of minimal qualifications do I need?

Nope, you can be a logistician, an administrator, a finance person and so on. Check out any MSF website for mroe detail

What will MSF do if it stops being able to raise enough funds?

Focus on the biggest crises! So prioritise our work on those countries where the needs are biggest and where other organisations find it tough to work. Such as Syria, such as Central African Republic. Perhaps we would not go to the Philippines in such a case

Have you ever seen the effects of micro-credit loans? If so, what were your impressions?

Honestly cannot comment

What is something regular people can do to help your cause?

You can support our work through donations, by working for us or by chamioning the cuase of people caught up in crises around the world, without having any responsibility for causing these crises. The world needs to care, and it starts with each and every person.

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Help others as you would help yourself.

Since MSF breaks the mold of your typical hospital workflow, clearly. As a result, I expect many of the tools that most doctors enjoy are not available to MSF (not just physical tools, but access to EMRs, medical software, etc.). I am personally involved with the electronic side of the healthcare workflow, but I only work with stationary hospitals and clinics.

What do you feel the biggest need is for MSF in terms of the (somewhat) recent push to digitize medical information? What type of product/solution do you wish you had because it would make your job easier?

All consultations and prescriptions and drug dispensing and that linked to our pharmacies, stocks and medical ordering. Wow, that be great!

Another question Arjan!

-In Syria you guys are working mainly in rebel-occupied areas, does that mean that the "other" side of the conflict doesn't get medical attention from MSF? How is this situation handled?

-I read that in the begginings of your career with MSF you worked as a logistician, what does a logistician do on the field and who can apply to this position?

I was a jack of all trades, doing administration, buying and transporting things, managing local staff. I was not reallty qualified but I managed, today the requirements are more strict I am afraid.

On Syria, you are very right. We are trying to be in dialogue with the Syrian government but so far we have not been able to get an agreement for us to work on the governmental side. So we can, for now, only work on the opposition side of the conflict. But that is not for lack of trying, and we will continue to try to seek openings and agreements with the Syrian government, too.

Hi Arjan! I am about to graduate from an undergraduate degree in International Relations and would like to go into Humanitarian Work. What advice can you give to someone just starting out about getting into this line of work?

International Relations is not the easiest study from which to jump into MSF. It helps also to have a practical skill on the side, that allows entry before you get to a position where such a study is really useful such at the level of a coordinator in the field.

Heya...over the years I've donated repeatedly. Thanks for your work!

Does MSF share resources on related projects (for example, Doctors Without Borders and the SmileTrain)? This seems like something that could increase efficiency of delivery of services, even if they services aren't a perfect match.

edit: Fixing the project name. Coffee has not set in.

We usually ask people to donate their time or their money. There are examples where we share resources but I do not know them off the top of my head

Thanks for the donations though!!!

Is it true that medications that are not used here because of the"expiration dates" can still actually be used? I seem to remember hearing that the dates are extra stringent, but actually many medicines are wasted due to this.

Better safe than sorry. Yes, that is my understanding, too. But I do not know the details so do not go using expired drugs on my say-so!

Would your organization be interested in a biologist with extensive lab experience ?

Yes, I have known people who worked for us with that precise background.

Hi Arjan! Thanks for doing an AMA. Just a couple of questions: I've also read Life in Crisis, and in it Redfield quotes Roy Brauman who defines a human as a "being who is not made to suffer". Do you think this is a good definition of what a human is, especially in the context of humanitarian aid?

How does MSF measure the success of a project? Is there a set of criteria that determines when a project has been completed?

How do you see MSF developing in the next decade?

Thanks!

Brauman is still hugely important and influental in MSF, so I would not want to contradict him. But honestly, his definition is great -- the emphasis is on the 'made to suffer'. Everyone does, of course, but not everyone is made to.

The success of the project depends on the purpose we set for it. But in MSF, it is always about saving lifes, restoring human dignity and trying to affect a change in the situaiton which causes the suffering in the first place. We can rarely REALLY change the politics of a crisis, and we are not a change agent either. But we should always try to put those that have political authority in front of their responsibility! They should know that we expect them to act and to resolve a situation.

In terms of its future, MSF should defend ACCESS to populations, defend its direct form of action and proximity to patients and populations rather than working through others, and defend INDEPENDENT AND IMPARTIAL work. We may be working against the tide, but someone needs to do it!

I don't have a question. Just wanna tell you to keep up the good work, it's awesome what you people do.

THANKS

Hi and thanks for your amazing work. Your comment about CAR is chilling, thank you for sharing, I hope to be able to do so one day. I am just wondering how MSF is links in with the other health providers, the govt and the UN in the Philippines just now - how do you know that you're operating somewhere where there are no other organisations? Do you share information with the other NGOs? Is there a way you let others know what you're doing so no one wastes their time? Do you ever share health advocacy and fundraising with other organisations so you can be more effective? E.g. maternal and child health, sexual health, etc. Thanks!

We certainly try to coordinate but it is not always as easy in practice. We are an action-oriented organisaiton. I am not saying other are not, but in my experience they have greater belief in coordination structures and processes. That said, we always share our work -- particularlty with the local and national authorities and also with medical institutes and universities, increasingly also in the non-western world!

What made you decide to do this?

A friend persuaded me. Talked me into it. It helped that he had a few beers ready on the side!

At first, it was romantic, and adventure combined with being able to help people. It then grows on you, as you mature in the organisation and in the work you do.

What is the most common problem that you and everyone else ins MSF see in the developing world, and what can we do to help?

Biggest resource AND constraint is people -- having the right person, for the right job at the right time!

What is your best piece of advice for an undergraduate student striving to become an MSF physician one day?

Thank you for doing this AMA!!

Finish your study, work with patients particularly the poor and the dispossessed, keep the motivation and apply -- we'd be honoured to have you!

I've asked this before, but when these things happen and in an ideal world what would you like to have at your disposal, in warehouses or on the ground that you don't have in these disaster areas?

People and transport logistics, mostly. Most of the other things we can very rapidly mobilise from anywhere in the world. We have regional supply hubs in the Middle East and in Kenya for instance, too.

It is not always necessary to have a presence to be able to react, but it does really help. In Haiti,we had teams who could response immediately when the quake hit becuase we were there already. There were some caught in the rubble, too, but fortunatelty they got out after 2 days.

Hi Arjan,

I have heard anecdotally that MSF is one of the more dangerous NPOs to work for, because they are often the last to leave when areas become more hostile.

Do you think there's any truth to this view?

We are willing to work in dangerous environments, but we are also amongst the most professional in the way we organise our presence, safety and security. And we do not accept ALL risk. So no I would not agree to this.

As an community health practitioner and herbalist, I am curious to know if you have worked alongside any "complementary and alternative" medicine practitioners, and what your opinions of such practices are in the situations you work in. In my experience, a great deal of the work in crisis situations revolves around sub-clinical and chronic conditions that conventional medicine has few tools to address, but CAM can be very helpful for.

Undoubtedly, having seen many indigenous modalities at work in the many locations you've been, and the local peoples' attachments to them, I am very curious to know what your opinion of such work is, and what role you see such methods playing in the work you do, and medicine in general.

Tough questions. Honestly, we work with tried and tested medical methods. But we are also open to piloting new things, as long as there is an empirical basis to it.

Some feel that we are too conservative when it comes to these matters. I, being non-medical, find it difficult to comment.