The international medical organization Doctors Without Borders/Médecins Sans Frontières (MSF) has long had a reputation of sending courageous medical providers into parts of the world affected by war, epidemic and natural disasters.
What might be lost in the group’s public image are the invisible wounds that professionals with the humanitarian group also treat.
“MSF is trying to get mental health in all of its projects because we believe there’s no health without mental health,” said Karen Stewart, a MSF mental health officer.
Stewart will speak in Tacoma on Sunday and in Olympia on Tuesday about her experiences with MSF. She has worked on 11 assignments in nine countries over the last 15 years.
“MSF On the Road: A Voice from the Field” is visiting nine cities across the Northwest through September. The events are free to the public and followed by a Q and A session with Stewart.
Stewart began working with MSF in 2004 and was most recently in Uzbekistan working on a tuberculosis project.
There, she set up a counseling team that helped TB patients understand how important it was to take their medication and what it did for them. Timely dosages of TB medication is crucial to the survival of the patient as well as the prevention of medicine-resistant TB strains.
“It’s very important for patients to truly understand what is happening,” she said. “That’s where mental health comes in.”
The implications are world-wide.
“We now have multidrug-resistance tuberculosis,” Stewart said. “The drugs we had are no longer working. So we need a whole new set of drugs. There’s even extreme drug-resistant TB.”
MSF has a reputation for staffing some of the neediest places on earth.
“If there’s a functioning government and a functioning health system and perhaps other non-governmental organizations active, then we’ll probably not go,” she said.
Doctors and other medical providers are not volunteers but they aren’t highly paid either. In the field, they are paid a small stipend and provided with health care and expenses.
When she first started with MSF, Stewart would take year-long assignments but eventually cut that down to six week-long stints. She hasn’t worked in the field since 2015 and now teaches at the University of Denver.
Stewart worked in Aceh, Indonesia after the 2004 tsunami and in an HIV/AIDS clinic in Lagos, Nigeria.
Getting people with HIV/AIDS into treatment is one of the main goals in Nigeria, Stewart said. The situation has improved in recent years but 53,000 Nigerians died of an HIV-related illness in 2018 and infections are up, according to UNAIDS.
“It still has stigma, it still has discrimination, it still has people who are in denial,” she said of HIV/AIDS. Other mental health challenges include the loss of a loved one and the individual’s own health.
“A person might find out they are HIV-positive only because their partner died,” she said. “They are dealing with grief and this new diagnosis.”
Stewart has responded to human-caused disasters as well. In 2013, she helped survivors of the Dhaka, Bangladesh garment factory collapse deal with their mental health issues.
When rubble from the eight-story building was cleared, the death toll reached 1,134.
The jobs in the garment factories are “hellish,” Stewart said, but still a step up from poverty or sex work.
Following the tragedy, Stewart’s team helped survivors deal with loss and betrayal.
“Many people had lost their mother or daughter or sister,” she said. “They knew the building was unsafe. They were told they had to go in. They were angry and felt betrayed.”
Stewart herself doesn’t provide counseling given cross-cultural sensitivities and language barriers. Instead, she sets up and trains local counselors.
Stewart has worked in former war zones and near them. They can present issues of trust.
“If there’s been a conflict for 20 or 30 years, nobody’s really sure who’s on what side,” she said. “When we come in, there’s mistrust between family members, friends and neighbors. We focus on bringing people back together.”
MSF counselors usually work in group settings, Stewart said.
“If needed, we can do individual (counseling) if somebody can’t manage in a group or need that extra care,” she said.
Stewart is relocating from Colorado to California. She has spent a total of five years on assignments for MSF.
Stewart’s wide ranging career, seeing people at the worst moments of their lives, has given her a broad perspective.
“Everybody is just trying to make do,” she said. “That’s what is striking to me, having traveled in so many places and worked in so many countries. We’re just all trying to do our best.”
‘MSF On the Road: A Voice from the Field’
- Who: Karen Stewart
- Tacoma talk: 2 p.m. Sunday, Sept. 15, Tacoma Art Museum, Murray Family Event Space, 1701 Pacific Ave., Tacoma
- Olympia talk: 6:30 p.m. Tuesday, Sept. 17, The Olympia Center, Multipurpose Room, 222 Columbia St NW, Olympia