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"Creativity Is Essential When Working In Troubled Regions"

Doctors Without Borders: "Creativity Is Essential When Working In Troubled Regions"


Photo: Tankred Stöbe

Doctor Tankred Stöbe, Doctors Without Borders; © Barbara Sigge

Civil wars, floods or an earthquake like the recent one in Haiti – Catastrophes like these demand a lot of hard work from doctors. Surgeries are performed in piece work under poor hygienic conditions while missing anaesthetics and drugs.

Tankred Stöbe is the Head of the German section of “Doctors Without Borders“ and spent time in 2004 after the Tsunami in Sumatra. talked with the doctor about emotional situations, ideas created out of necessity and the motivation to help under extreme conditions. Mr. Stöbe, in a troubled region due to the absence of an operating table, sometimes a kitchen table is quickly transformed to perform surgeries. Have you ever personally experienced something like this?

Tankred Stöbe: Yes, Creativity is essential when working in troubled regions, since there is never enough of anything. Drugs, diagnostic equipment or medical instruments are not readily available. Doctors have to improvise to help people in a quick and effective manner. That is not always an easy thing to do, but actually it is the true medical artistry. Could you give us an example?

Stöbe: While in Indonesia, I saw an old man in a hospital who presented all the symptoms of an acute heart attack. The hospital was not equipped to provide treatment. And since the necessary drugs were not available at the hospital pharmacy, I first had to buy them at an outside pharmacy. That is how we were able to save this man’s life. Aside from drugs, surgical instruments are often missing. After the Haiti Earthquake some doctors were said to have amputated arms and legs using hand-or buzz saws.

Stöbe: Yes, while the staff of relief organizations is bringing the necessary tools to the location, planes might not be able to land due to the destroyed infra structure, like it was in the case of Haiti. And if hospitals at the location are also badly damaged, my colleagues sometimes resort to using a hand saw to save a life. In 2004, you were on assignment in Sumatra after the Tsunami. Did you have to perform treatments that were especially terrible for you?

Stöbe: I remember one man coming to our clinic with a decomposing hand. His injury was too far progressed and we had to amputate the hand. That was tragic, because the man was a tailor. He did not come to the hospital sooner, because he was afraid that he might not be able to use his hand after any treatment. That was a false decision with terrible consequences. At another assignment shortly after the civil unrest in Liberia in 2003/2004, we had three men with severe burns coming to us – after an alleged burglary they were doused with gasoline and lit on fire. We could not save these lives, but were at least able to make them more comfortable by administering heavy pain medication.

Photo: Damaged house after a hurricane

In troubled regions quick help is essential, especially from doctors; © SXC If there are many casualties – such as after the Tsunami or after the Haiti Earthquake - doctors often resort to “triage“. This is a treatment procedure where injured people are not treated in the actual order they came in, but rather by severity of the case or by determining cases that promise the most success. By doing so, doctors make life and death decisions. How do you feel about having to do make this sort of selection?

Stöbe: Triage becomes a very emotional matter which needs to be learned, since it is only natural that you want to help the first person that comes to you for help. If there are many patients though, this could prove fatal, since the ones that need urgent and immediate help might not get it in time. For local doctors, Triage is an even more emotional matter than for an external doctor like me who has no personal relationship with the injured person. Sometimes the local doctors need to treat friends or relatives. This is why for these sort of treatment procedures, doctors need to be trained and educated time and again, since Triage – even if it is hard to do - is really more effective. You get to see a lot of suffering, but you are also only human. How do you manage to do a good job despite working under such extreme conditions and enormous stress?

Stöbe: My work is emotionally draining and often just a drop in the bucket, but it is also very rewarding. At the end of the day, I know I have accomplished a lot. I realize that I am more challenged working in a troubled region than I would be working in Germany. There, I am merely a grain of sand in a Healthcare system which functions well with or without me, but in those troubled regions people’s lives depend on my work. With this knowledge, I am still able to do my job under extreme conditions. You have worked with „Doctors Without Borders“ since 2002. What motivates you to do this work and how do you deal with the stresses and strains?

Stöbe: We often work under bad conditions. The climate is different, accommodations are basic and the often delicate security situation in civil war regions presents limitations for the staff. Yet I get a lot back and this motivates me. It is a great asset to meet people and get to know other civilizations. Sometimes I think I am getting more from this than I give. Since I never work alone and always with a team, I can always talk to my colleagues about my experiences. This is very important and helps me to deal with any strains. At the moment, you are working as a doctor for a Berlin hospital. Are you going to trade this job for another job in a troubled region in the near future?

Stöbe: Not permanently, but I continue trying to work on a project in a foreign country for a few weeks. I hope that I will be able to do this once a year during my vacation time or when I take some comp time.

The interview was conducted by Simone Heimann and translated by Elena O'Meara


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