Dr Wing-Yan Kwong, recipient of 2016 Hong Kong Humanity Award, began her devotion to humanitarian service after completing her third-year medical studies, when she took a gap-year to visit rural areas in Cameroon, Africa. Despite her near-death experiences from contracting malaria twice, the experience did not deter her. Rather, it made her stronger and more determined to help those in need.
After becoming a qualified practitioner of Emergency Medicine, Kwong spent her annual leave, eventually quitting her job, to participate in humanitarian services, providing treatment to patients in Ethiopia and Zambia. More recently in May 2015, she went to Nepal with the Red Cross to serve earthquake victims.
At the time of this exclusive interview, Kwong has resumed work in the Accident and Emergency Department of a public hospital, but plans another trip soon. She shared with MIMS about the practical aspects that aspiring medical field workers need to consider before diving into humanitarian services.
I am interested in becoming a medical field worker. But when should I start?⨯ Before graduation
Despite Kwong’s decision to take a gap-year before graduation, she does not recommend that students follow in her footsteps.
“It’s possible for students to contribute to the project as a volunteer, but it would be difficult for them to contribute as a doctor since they do not have any clinical experience,” Kwong explained.
“Additionally, as I put aside my studies for the gap-year, I needed to spend a lot of extra time and effort to refresh what I had learnt before, and simultaneously catch up with the learning in years 4 and 5. To me, I’d say it’s a bit risky academically, if you choose to go before graduation,” she added.
⨯ After internship training
Similarly, Kwong does not encourage graduates to become international field workers upon finishing internship training. As a result of a lack of clinical experience, coupled with the unfamiliar and tense environment, they would offer little help to the mission, but instead be at high potential to do harm to patients.
✓ After a few years of clinical work
Kwong believes that doctors can contribute more as a medical professional after acquiring a few years of clinical work experience. However, she noted that it may be necessary to give up a training post at a reputable hospital for a mission, and upon return from the mission, returning to the original training centre may not be possible.
✓ After fellowship
Alternatively, doctors may consider participating in humanitarian work after passing the exit exam and securing a specialist position. Nevertheless, this is also usually the time when they tend to get married, or give birth, as it is right after their 6 years of fellowship. In this case, these life events may need to be delayed if they decide to take up a mission.
⨯ After retirement
Despite the clinical experience acquired over the years, doctors at this age may find it difficult to adapt to the unpredictable scenarios, such as a highly stressful environment in war zones or the uneasy living conditions in third-world countries.
Breaking the illusion - participating in humanitarian work does not mean putting one’s life at riskAnother most common situation a doctor needs to consider before joining a humanitarian organisation is the objection from their parents.
“If their parents are extremely worried, maybe they need to reconsider if they should join the mission or not,” Kwong suggested. “One of the reasons why the parents object the doctors in going to missions is probably because the doctors are still too young. In this case, they may consider going at later ages. Another reason is that their parents have probably come across news that report casualties in war zones, or deadly diseases in third-world countries. If so, the doctors may need to provide some concrete evidence to explain to their parents that the missions are not that dangerous,” she continued.
Death caused by violence while working with humanitarian organisations was often under the media’s spotlight. The unfortunate Kunduz hospital airstrike killing 14 Médecins Sans Frontières (MSF) staff members was one example which caught the media’s attention, and made headlines of many media outlets. As such, wide media coverages might create an illusion that participating in humanitarian work means putting one’s own life at risk.
According to the data provided by the Hong Kong Red Cross (HKRC), there was no recorded volunteer casualty on mission in the past 10 years, except for one minor case where the volunteer suffered from a twisted ankle.
Although an Indonesian doctor who worked with the MSF Hong Kong branch died due to violence while he was on mission, no Hong Kong people died due to violence while working with MSF over the past ten years. All of the 14 MSF staff members killed in the airstrike were national members and there were no international staff killed in 2015 and 2016 while working with MSF on the field.
“Additionally, it might be useful if doctors can share with their parents the stories published in Red Cross’s website or MSF’s blog. This way they can understand more about the positive impact we can bring to the patients and the community,” explained Kwong.
Red Cross, MSF or other missionary groups?Apart from safety issues, another pressing question when one decides to become a medical field worker is: Which international humanitarian aid organisation should I join?
Among numerous organisations, Red Cross and MSF are two of the most popular choices medical field workers would consider. Based on her own experience, Kwong has highlighted a few requirements to take note of:
Besides Red Cross and MSF, Kwong has also suggested doctors consider other NGOs such as Voluntary Service Overseas (VSO) and Health In Action (HIA). “Smaller missionary groups offer more flexible schedules for missions. Many of their missions are shorter in duration and require less humanitarian service experience,” Kwong said. “However, they may have fewer opportunities to go to frontline or experience emergency situations. The missions are more likely delivering health education in mobile clinics or providing assistance in regional hospitals. Still, they are good options to start with,” she added.
Should I choose a specialty which is more welcomed by humanitarian organisations?While some specialities such as obstetrics, orthopaedics and anesthesiology are usually more welcomed by humanitarian organisations due to higher demand, students who are determined to become field workers may ask if they should go for these specialties during their internship training.
“Personal interest comes first. If you choose a specialty that you are completely not interested in or uncomfortable to handle, you may find it extremely challenging throughout your medical career,” Kwong emphasised.
Apart from personal interest, Kwong suggested students divide the specialties into surgical and non-surgical streams for their easier considerations. While the surgical stream is usually more popular for humanitarian work, Kwong explained non-surgical stream specialties such as paediatrics can also contribute to humanitarian missions. They may, however, need to stay longer in the field in order to make an impact on the community.
How long do I need to go for?According to Kwong, the duration of missions usually depends upon the stage in which medical student or doctor chooses to participate, as well as the doctor’s specialty.
With resources invested to ensure field workers can adapt to the local environment, humanitarian organizations usually require students or junior doctors to stay for longer periods, as they often need more time to make up for – and prove – their worth. Usually, these missions would last for 6 months to 1 year.
Meanwhile, doctors with more clinical experience have the option to go on shorter missions. For example, surgeons can choose missions that last for a few weeks only, as they can provide treatments for a large number of patients every day. On the other hand, for specialties such as Emergency Medicine and Paediatrics, doctors may need to stay longer to offer care for more patients.
“To start with, doctors can look for shorter missions organised by smaller missionary groups to see if they are really interested in the work, and if they can cope with the working environment. One month may not be sufficient as the doctors may need time to adapt to the local culture. A three-month mission is probably more suitable,” Kwong suggested.
What if I am working in a public hospital and I want to join a mission?“Doctors in public hospitals have 25 days of annual leave. Since we cannot carry forward the entire year’s leave to the following year, at most we can only accumulate several weeks’ worth, which allows for a short mission. If you want to join a mission that lasts for three months, then you are left with two options - taking no-pay leave or quitting your job,” said Kwong.
It happened to her in February 2015, when Kwong decided to quit her job to study tropical medicine in Liverpool for three months. After the course, she joined Red Cross as a medical volunteer and headed for earthquake-stricken Nepal, providing voluntary services in the disaster zone for another month.
Kwong also mentioned that whether one can take unpaid leave very much depends on the manpower available in each hospital. Considering the current manpower shortage in public hospitals, she admitted that it is highly unlikely for doctors to take unpaid leave for several months.
Any interview tips?Once decided which international humanitarian aid organisation to join, it is time to prepare for an application.
Asked if there are any tips in getting through the application and passing the interview, Kwong explained they just want to recruit people who are passionate in humanitarian service. “It’s not doing public examinations. You do not need to spend a day to recite the vision and structure of the humanitarian aid organisation. As long as you have a general idea on that, it’s fine. It is rare for them to ask you scenario questions when you have to answer what you would do when you face certain medical conditions,” Kwong said. “Therefore, just be yourself and be honest on the answer of why you want to participate in humanitarian service,” she continued.
Kwong added, it is likely the applicant needs to undergo a group interview where he/she needs to interact with others to achieve a task with concerted efforts. “Since we need to work with field workers who are totally strangers before the mission, this requires a high degree of teamwork and effective communication,” she explained.
Other than the specialty a doctor is specialised in, Kwong also recommended aspiring field workers to study infectious disease courses, since it is very likely for field workers to encounter these diseases in third-world countries. Without relevant training, field workers may not be capable to deal with such situation. Apart from the infectious disease course organised by Liverpool School of Tropical Medicine that Kwong is enrolled in, she also suggested other shorter courses, such as the courses organised by The Hong Kong University, which do not require a three-month time to study overseas, can also equip doctors with relevant knowledge.
Red Cross’s selection / interview process:1. Fill in the volunteer registration form (can be downloaded from Red Cross’s website.
2. Shortlisted applicants will be invited to submit their CV and a telephone interview will be arranged.
3. After passing the telephone interview, candidates will be requested to send copies of professional certificates and be arranged for face to face interview.
4. Candidates who pass face to face interview will be accepted as volunteers.
5. Upon completion of the training provided by the Hong Kong Red Cross, volunteers will be assigned/ be on standby for overseas humanitarian missions.
MSF’s selection / interview process:1. Read the ‘Self Reflection’ section to have a better understanding of the challenges that come with international humanitarian field work. Proceed to application at the end of the page.
2. Applications are reviewed by Field Human Resources Officer for suitability as field worker
3. Shortlisted applicants are asked for a phone interview with a Field Human Resources Officer
4. Candidates who pass the phone interview are invited to the recruitment and assessment session
5. Candidates who pass the assessment join the pool
Setting the right expectationsSpeaking from her numerous experiences serving in various countries, Kwong reminded doctors not to set expectations that are too high for themselves. She specifically noted that doctors may end up with a feeling of ‘incompetence’, regardless of how brilliant their track records were in Hong Kong.
“They may have never heard of the infectious disease since it’s localized, and feel poorly because of that. In this case, Hong Kong doctors may need to exchange knowledge with the local doctors there,” she said. “Because of the lack of education opportunities, it is an extremely tough and challenging journey for the people there to become doctors. They are very determined to save lives as they are seen as a rare hope for the residents due to the extremely high patient-doctor ratio,” she continued.
It is also better for doctors not to overestimate the impact they can make. “Sometimes, due to a lack of resources in third-world countries, you can only find ways to relieve the pain and symptoms of the patient even when you know the patient needs a certain type of therapy or medication to recover, which might be easily accessible in developed countries but not locally,” she added.
Kwong recalled a disappointing case in Nepal when an elderly patient had travelled a long way from her hometown to the Red Cross clinic.
“We confirmed that she was suffering from joint dislocation, which would have been easily managed if we could have dealt with it earlier. However, since her joint had been injured for 3 weeks and became stiff, simple close reduction was not successful. Hence, we found it necessary to send her to a hospital in a larger city for an operation. Sadly, we failed to persuade her, as she needed to go back to her home and take care of her family members. Eventually, we could do nothing but to watch her leave with a dislocated arm,” she described.
Martin Luther King, Jr. once said, “We must accept finite disappointment, but never lose infinite hope.” Although there may be around 20–30 percent of cases in which doctors can offer little help, 70–80 percent of cases still urgently require these volunteer doctors’ helping hands, which is the reason why Kwong still continues to strive on, giving hope to those in need. MIMS
About Hong Kong Humanity AwardThe Hong Kong Humanity Award is organized jointly by the Hong Kong Red Cross and Radio Television Hong Kong. Launched in 2007, it is the very first award of its kind in Hong Kong which aims to give tribute to individuals in society who exemplify the very spirit of humanity by putting it into practice and action. Through honouring their humanitarian deeds, the organizers hope more people will know about the universal value of humanity, spreading humanitarianism to all levels of society. Learn more: www.redcross.org.hk/ha
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