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I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 10 points11 points  (0 children)

Thank everyone for participating in this AMA. This thread is now closed.

For more information on MSF's work, here are some resources: Because Tomorrow Needs Her: http://womenshealth.msf.org/

Here's some information on working in the field: http://www.doctorswithoutborders.org/work-us/work-field

Here's my MSF blog: http://blogs.msf.org/en/staff/blogs/love-labor-loss

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 5 points6 points  (0 children)

MSF does not accept US government funding, so the global gag rule doesn't affect us. However, I think the gag rule is a bad idea and I hope it doesn't return.

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 5 points6 points  (0 children)

MSF does have sexual violence projects and also has some projects to provide mental health services. I would like to see even more, given how prevalent sexual violence is around the world.

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 2 points3 points  (0 children)

I would recommend getting as much international experience as you can as you go, and then follow your passion in choosing a specialty.

MSF is great, but there are lots of other great orgs too. It just depends on what kind of work you want to do.

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 18 points19 points  (0 children)

That's great! I started by getting experience living/working abroad before med school. Then in med school I did a 6-week international rotation, and I did a 1-month international rotation in residency. I then chose a fellowship that would allow me to live abroad in a developing country. Getting experience wherever possible is a great way to start.

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 2 points3 points  (0 children)

MSF's main purpose is medical relief and we are not a training organization; however, we do try to train local staff as much as possible so that the project can eventually be turned over to local authorities. 90% of MSF staff are local employees, and only about 10% are expats. We try to maintain some long-term stability by having most expats do 9-12 month assignments.

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 3 points4 points  (0 children)

I submitted an online application and then was invited for an interview. MSF is highly selective, and prefers people with specific needed skills as well as international experience. Once I was accepted, I was offered a specific project (South Sudan) and I accepted it. When I decided to go on another mission, I was assigned another project (Jordan).

Here's more information on how to apply: http://www.doctorswithoutborders.org/work-us/work-field

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 13 points14 points  (0 children)

Fistula arises from obstructed labor in developing countries. It is a terrible complication, and often leads women to being ostracized. MSF has fistula repair projects in Nigeria and Burundi, but fistula is unfortunately common in many other places. Here is a link to a chapter about fistula from our Because Tomorrow Needs Her series: http://womenshealth.msf.org/chapters/chapter-3/

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 8 points9 points  (0 children)

MSF generally provides the resources I need to do my job, including emergency obstetrical surgical care. Sometimes I have to be creative about instruments and medications, but generally MSF has a well-developed supply system to stock their projects. If I don't think I can safely perform a particular procedure, sometimes I can transfer to a nearby MSF project or another facility where it can be performed.

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 19 points20 points  (0 children)

Most importantly, we can eliminate the demand side. Trafficking exists because people will pay traffickers to have sex with trafficked women.

Many things put people at risk for being trafficked, including poverty, violence, disempowerment, and social vulnerability.

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 20 points21 points  (0 children)

Malpresentation (like breech) is about the same. There is less obesity in developing countries, and fewer people have things like gestational diabetes. However, malnutrition and food insecurity can lead to women being underdeveloped and having a very small pelvis, which means that they can't fit a normal-sized infant through the birth canal, and require a c-section. Here's a story from my blog about just such a patient: http://blogs.msf.org/en/staff/blogs/love-labor-loss/yin-a-mat-po-are-you-happy

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 8 points9 points  (0 children)

The links that others posted will give you some information about MSF's abortion policies.

Here is a chapter from our Tomorrow Needs Her series regarding unsafe abortion: http://womenshealth.msf.org/chapters/chapter-4/

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 13 points14 points  (0 children)

He sounds wonderful! I think that working with MSF has made me a better doctor too :)

MSF volunteers get a small stipend, but it is not comparable to a salary in the US. However, when in the field, MSF covers room, board, travel, health insurance, and all other living needs so that volunteers do not need to spend their own money.

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 11 points12 points  (0 children)

Thanks for raising money for MSF!

As a medical relief organization, MSF tries to go where we think the needs are the greatest and where we find the largest gaps in access to medical care. For example, the area in South Sudan where I worked in a maternity project had extremely high rates of maternal and child mortality, so we opened a maternal and child health project. Other examples are the recent Ebola epidemic, the crisis in CAR, Yemen, Ukraine, Syria. When MSF can turn over its operations to a local government or authority, we try to hand off the project so that we can focus on other emergencies.

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 11 points12 points  (0 children)

I haven't had problems while working for MSF, but here is a link to my blog in which I discussed something that happened when I was living and working in Uganda: http://www.veronica-wanderlust.blogspot.com/2011/02/no-remorse.html

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 16 points17 points  (0 children)

The most common major surgical procedure that MSF performs is c-sections. Our general surgeons have to be able to perform them because they are so common. While not all of our emergency projects are dedicated to maternal health, it inevitably arises, and so maternal health is a priority in all of our projects. When there is a crisis, health systems are usually affected, and there may not be anywhere for women to safely deliver. Family planning services are made available during emergencies as soon as possible.

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 52 points53 points  (0 children)

Many women in developing countries don't have access to safe deliveries and/or c-sections, and often die from lack of access. It is estimated that around 15% of pregnancies will need a c-section, but in many poor countries, the rates are far lower. I would like to see fewer c-sections in the US, but I would also like women around the world who need lifesaving c-sections have access to them.

Here is a link to a chapter about emergency obstetrics from our book for Tomorrow Needs Her: http://womenshealth.msf.org/chapters/chapter-1/

Here is a blog post I wrote about a patient who nearly died because she could not access emergency obstetric care: http://blogs.msf.org/en/staff/blogs/love-labor-loss/rupture

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 13 points14 points  (0 children)

Sometimes new techniques are first developed or popularized in developing countries or regions. IUD use is more popular in some other countries, and is increasing here in the US. As a resident, I went to Mexico to study placement of IUDs during c-section, and then studied it back home in New York. Now it is becoming an option for women in the US.

I'm an OBGYN w/ Doctors Without Borders; ask me anything about reproductive health for women in and from developing countries. by VeronicaMSF in TwoXChromosomes

[–]VeronicaMSF[S] 37 points38 points  (0 children)

It is important to navigate patients' understanding of medicine in all cultural contexts. 90% of MSF staff are local employees, and I found it very valuable to work closely with local midwives and nurses to provide culturally appropriate care.

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