IamA Executive Director of Médecins Sans Frontières/Doctors Without Borders (MSF) Stephen Cornish, ASK ME ANYTHING!

How is MSF able to keep up with all the strain of so many emergencies all at once (Ebola, South Sudan, CAR)?

With so many major crises happening in the world right now, it’s easy to feel pulled in many directions at once. But it’s important for us to remember that at the heart of all these crises are individual people. If we focus on saving one life at a time, one community at a time, then we make a significant contribution to each crisis as it occurs.

When did you decide to become awesome?

MSF is an awesome organization, made up of ordinary people working for an extraordinary cause.

You must be exposed to some terrible human suffering. How do you keep a professional detachment?

Yeah this should be a great answer, would love to know how day to day one has to deal with the stress.

It is a balance of both humanitarian empathy and professionalism that I find helps. I'm also very fortunate that I am able to advocate on behalf of the populations we help, which in turn helps me come to terms with some of those concerns.

With regards to the Ebola emergency in West Africa, does the media coverage of the issue diverge from the reality? If so, how has that effected the overall response to the crisis?

At one stage the coverage was more focused on domestic concerns in the West when more focus was needed on opening beds and treating patients on the ground. At the time it was an unhelpful distraction.

Other than donating, what can your average person do to make (any) impact on international health?

Getting informed, informing others and getting involved. Donations aren’t just about money, but also giving your time, your empathy and your compassion. In all walks of life, people make decisions every day that impact others, so being conscious of those choices and acting accordingly is a valuable way to make a difference.

Thank you for your reply and all the work you do!

You're welcome!

Dr. Cornish I am wondering how did you get involved with MSF and humanitarian work in general?

Actually, I'm not a doctor, though my mother would have wished so. As to your question, I started on the project management and security side, and worked my way up.

I once considered joining up with MSF/DWB but I am a respiratory therapist and it appears that you don't hire RTs. Nevertheless, I am a huge supporter of your mission and your work. How does MSF decide to dispatch to a particular area of the world, and, when they do, how do they manage security expectations? I would imagine certain areas could be downright hostile.

Yes indeed, some areas are downright hostile. In fact in Syria, South Sudan, etc, that would be an understatement. But MSF has extensive experience managing teams in conflict and other at-risk settings, and where possible we do so through community acceptance of our medical care.

Any chance Liberia will get it under control?

Hopefully, now that the international community appears ready to scale up, things on the ground in Monrovia will begin to improve.

Have you worked with pharmacists in the field? And if yes, what was their role?

I am a pharmacy student interested in working for MSF and I'm curious about how they fit into the field team.

Yes, many times. Pharmacists play an important role in many of the places where MSF works. They're responsible for importing and stocking medicines and other medical materials, and preparing our medical orders for distribution to various clinics and hospitals in our projects.

Hi, I've thought about your org a few times in the last few years. I have often thought it would be good to help you out. I work a mission style semi-volunteer based org. I have worked in and managed a shipping pallet factory. Also a kitchen feeding 40 people a day. Both positions for over a year each and in the same organisation. So, I have several skills, like pallet building, forklift, driving ( just car), warehousing, personnel management, food catering and stock management. Currently I work in a rehab helping men (18-80 y/o) overcome various addictions, leading them in learning to make better decisions, like a counsellor. Not that it's a job interview or anything. But I've wanted to travel and help people in undesirable locations with these skills. I have a pension which helps with volunteering. If I was to serve with you guys in those ways seasonally, like a mission trip. How are living expenses at home looked after, such as a lease and other on going contracts/ expenses? Would the expectation be that I drop everything? Would I need to pay for my own travel?

We have volunteers of all ages and from all walks of life. Sounds like your work experience and empathy could be a fit. Check out our recruitment page for more information.

What are your day-to-day living conditions? How much free time do you have and do you use that time to become immersed in the community? I know MSF has a big emphasis on involvement with the community, but I was just curious as to how that translates when working in potentially dangerous areas like S. Sudan

It’s vital to understand the community in which you work, and to work with and train local actors. Responding to emergencies often leaves little down time, but with the time the teams do have, they try to immerse themselves in the community as much as possible.

And what is your living situation? Do all the volunteers stay together in dorms or a house or make-shift housing?

It depends on the field mission, but in my last visit to South Sudan, the teams were living communally under tents in displaced person camps. But in more established missions, it's not uncommon for teams to live in anything from tukuls (African huts) to houses.

What you do is amazing. I admire your bravery. How long are you typically away from home when you go on a humanitarian mission?

Thank you for doing this AMA.

In my earlier missions, I would be in the field for anywhere from 3 to 24 months. But now as a director based in Toronto, I usually go to the field for 3 to 4 weeks at a time.

Westerners seem highly concerned that Ebola could come to western nations, but I am curious about your thoughts of whether Ebola could be a threat to the India/Thailand/Indonesia/SE China region. There are a highly dense population of people in some of those areas living in conditions not far removed from those in West Africa. Would an outbreak in one of those regions likely be quickly contained, as was seen in Nigeria?

My second question if you have time relates to where the health care workers are going to come from to contain the current epidemic in West Africa. I read that it takes 400 workers to properly staff a 100 bed clinic. With a need to isolate 70% of those infected and likely 20,000 infected or more by November, are alternative methods being explored to control the epidemic, such as home care? It seems unlikely that 60,000 to 80,000 health care workers would be found by November.

Ebola being introduced to any highly concentrated population without the proper means to respond would be a matter of serious concern. In terms of capacity on the ground, 90% of staffing on the ground comes from the local population, which needs to be supplemented by the international and specially trained medical teams we've been asking. It's not enough to subcontract this epidemic, we need to tackle it head-on.

What is your biggest personal achievement to date?

Recovering from Ramsay-Hunt, a debilitating condition that meant I was off work for a year, after which I needed to relearn how to walk, how to read and how to focus. It was a major achievement to re-enter the work force after that experience, let alone being able to continue contributing to MSF in a leadership position.

How big is the threat of societal breakdown and mass exodus from areas infected with Ebola, particularly in Libera, over the coming 6-8 months, assuming that resources cannot be dispatched fast enough to halt the outbreak, and only slow it moderately?

Do the governments of nations surrounding these countries have plans in place to handle the large refugee populations they could see if things continue to decline?

Care to estimate what the real number of cases and deaths are right now?

Thanks for your service to our world! We could always use more people like yourself.

The estimates of these numbers vary widely, and given that we’re in an unprecedented epidemic and in uncharted waters, there is no certainty, just a general consensus that the official numbers are under-reported, but to what degree nobody can know. In Liberia, there’s now a general understanding and acceptance of the severity of the Ebola epidemic, so people are actively seeking care. Unfortunately, there are not enough treatment facilities on the ground, so we are having to turn people away, which is not only abhorrent but perpetuates the continued spread of the disease. Our current focus is on bending down the curve of the epidemic, so speculating on what the future holds is merely that, speculation, and won’t do anything toward bringing the situation under control.

I imagine that the work you do must at times challenge your faith in humanity. If so, who or what fills you back up when you've been exhausted?

It’s true that in our work we see some horrible things. But we also see some of the best that humanity has to offer. Even in the midst of conflict, people strive to feed their families and raise their children, which is what is truly courageous. All that said, you have to know when you’ve reached your own limits. You can’t give to others if you don’t take care of yourself, too. I like to hike in the mountains and work on my hobby farm in order to recharge my batteries.

FROM /u/erasium "What are the best case scenarios at this point, the worst case scenarios, and then something realistic based on your understanding of where we are right now?"

The best case is that we manage to bend the curve of the epidemic, while the worst case is that it is not contained and continues to spread.

Thanks for doing this how hard is it going into a hostile environment where there are many people who don't like outsiders of their country?

There's something about the doctor-patient relationship, especially when it is developed around life-saving care, that breaks down barriers and helps enable our work on the ground. Access is often only possible because of the nature of the work we do. It's remarkable how even the most hardened warriors can understand the need for children on all sides to be vaccinated, for women to have access to safe delivery and for those wounded in conflict to receive care.

Obviously, MSF has doctors and nurses that work hard to help others across the world. What are some people/position within your organization or that you work with that makes things happen? For your response to the Ebola outbreak, how many groups are involved?

And if you have time, do you have any stories of times when someone or a group was able to provide unexpected help to MSF?

Other than the doctors and nurses we generally hear about, there are all sorts of other roles that make up the team, and it’s the teamwork that’s key to responding to any of the complex emergencies that MSF faces. Some of those roles include logisticians, water and sanitation specialists, psychologists, financial coordinators and administrators and more. Our combined Ebola teams are now made up of more than 3,000 people, working under relentlessly challenging conditions. One of our workers commented that when facing the Ebola epidemic, it felt like running behind a forest fire with a water gun.

Do you believe serum infusion is a viable method of Ebola treatment in Africa until a vaccine becomes available? If so, what obstacles can you see in its delivery?

There are a number of secondary activities being considered, but for MSF the primary focus remains opening and staffing centres and treating patients in order to curb the epidemic.

/r/DoctorsWithoutBorders Mod here, thanks for doing this IamA - What experiences in your life do you think best prepared you for your current role in MSF? How does one go from logistical work to running shop?

Nothing can fully prepare you for a life with MSF. That said, being a country director with MSF teaches you how to juggle multiple critical priorities and dossiers at once. Trying to master that juggling game is an ongoing endeavor, but the truth is that I’m humbled to lead such a great team and work for such an impactful organization.

is there a difference between symptoms from previous occurrences and this one ? if there is..why ? and what is a difference ?

In previous Ebola outbreaks, they occurred in isolated regions and we managed to contain them within months. This time, cases have reached urban areas, and the outbreak is spreading exponentially.

false negatives ? why ?

How many in % form 100 cases ?

False-Negative Results of PCR Assay with Plasma of Patients with Severe Viral Hemorrhagic Fever

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC139694/

Our information divulged that on the 17th of this month, his specimen was taken and the result, which came on the next day (July 18), proved negative. Not being satisfied, the report further divulged, the ailing Catholic hospital director decided to seek further treatment abroad, but his trip was subjected to Ebola test. It was based on this that he did another test on Tuesday, July 29, 2014, which proved positive, contrary to the first test he underwent.

http://allafrica.com/stories/201407310957.html

Soft tissue in brain and ebola. Do you have any information about ebola attacking soft tissue in brain (cerebrum) and its influence on cognitive ability. or to explain it in other way..people becoming zombies and attacking other people.

There was report about patrick sawyer (Nigeria / Liberia patient )attacking hospital stuff.

FrontPageAfrica has now learned that upon being told he had Ebola, Mr. Sawyer went into a rage, denying and objecting to the opinion of the medical experts. “He was so adamant and difficult that he took the tubes from his body and took off his pants and urinated on the health workers, forcing them to flee.

http://www.frontpageafricaonline.com/index.php/news/2506-sawyer-s-final-hours-in-lagos-indiscipline-rage-strange

Is that type of behavior caused by ebola attacking (destroying) cognitive functions in the brain ?

Interesting question. I really don't know.

There are more news of humanitarian workers being targeted in conflict region recently, during your time with MSF, do you think it has gotten worst?

Unfortunately, we’re seeing a resurgence in attacks on healthcare facilities in many conflicts, which affects patients as well as healthcare workers. I’m just back from South Sudan, where in one hospital, patients were even killed in their beds. This is a disturbing phenomenon, which must be addressed by warring parties and countries, who must respect civilians, medical facilities and humanitarian workers.

What do you think is the primary cause of the increase in attacks? I guess it must be different for each country, but do you see anything that could be done to reduce it? Also, do you ever see that the outspokenness of MSF could possibly jeopardize the safety of the MSF workers?

We’re seeing a progressive erosion of humanitarian law and respect for the Geneva conventions. In practice, this means that civilians and civilian spaces are increasingly coming under fire rather than being protected in war. Part of the reason for this is the increase in civil conflict, where wars are being fought within cities and populated areas, which increases the risk. Secondly, even popular uprisings have been marked by the criminalization of medical care, where patients have been arrested for seeking care and doctors for giving it. These two trends taken together pose a serious risk to hospitals and healthcare workers worldwide. While there are potential risks in being outspoken, we try to measure these risks, and there are possibly greater risks to remaining silent.