Health and medical work can be divided broadly into clinical and non-clinical roles. The clinical sphere involves direct patient care—think of a field nurse in the Democratic Republic of the Congo or a surgeon working in a private hospital in Qatar. But it can also involve training programs, capacity building or research.
In the non-clinical sphere, professionals with expertise in public health work to address health issues that affect entire populations. The focus of this work is on disease prevention and on education that aims to promote healthy behaviours. It tries to prevent health problems by developing educational programs, recommending policies to government, administering health-related services and conducting research. Many people with clinical training and experience (physicians and nurses for example) contribute to global public health efforts; but solutions also require non-clinicians with expertise in disciplines like biostatistics, behavioural and health science, epidemiology, health services administration and environmental health.
In terms of international careers, there are opportunities internationally in both the clinical and non-clinical spheres in a wide variety of roles, from work in the private sector, to global health initiatives and programs, to humanitarian aid missions.
Humanitarian Relief
Emergency humanitarian relief work becomes necessary when local healthcare systems are overwhelmed by crisis situations—natural disasters, disease epidemics or conflict—and additional outside help is required. These situations typically call for a range of both clinical and non-clinical professionals throughout the various stages of the crisis—from first response to longer-term support.
Early on in an emergency situation, highly skilled and very experienced practitioners are sought to assist overwhelmed local health and medical professionals. Surgeons, anaesthetists and medical professionals with experience in emergency medicine will be needed. In the event of natural disasters like earthquakes, where crushing injuries are common, nephrologists may be needed (crush injuries can cause kidney failure). Mental health professionals may be called upon as well, particularly in cases of violent conflict. Disease outbreaks also require the expertise of experienced public health professionals, who work to determine the source and extent of an outbreak, the effectiveness of interventions and may also support community education programs, monitoring and screening to prevent further spread of disease.
Médecins Sans Frontiéres' (MSF’s) “Who We Need” list illustrates the broad range of medical professionals required for humanitarian missions. It includes: nurses (including OR nurses), physicians (in particular HIV and TB specialists, paediatricians, anaesthetists, surgeons, ER physicians, obstetrician-gynaecologists, and infectious disease specialists), midwives, mental health specialists, epidemiologists, pharmacists and laboratory specialists.
Over time, as a crisis is brought under control, slightly less experienced professionals may be recruited by aid organizations, to assist under the guidance of those with more experience. At this point, the focus of the aid effort may also shift from emergency medicine to rehabilitation and rebuilding the capacity of the healthcare system. Allied health professionals like physiotherapists, occupational therapists and psychologists may be called upon.
Owing to the intense, sometimes dangerous, often unstable, and frequently uncomfortable living and working conditions, humanitarian relief assignments are normally short- to medium-term—lasting anywhere from one to six months, but sometimes as long as two years.
Sharon Janzen, a registered nurse currently working with the Center for Disease Control (CDC) has been on MSF missions to Somalia, Guatemala, Liberia, Sudan, Nigeria, Sri Lanka and Nigeria. “My first mission,” she says, “for just over six months, was in Somalia. It was what you would call a ‘classic MSF’ or ‘old school’ mission. ‘Bush medicine’ was practiced here. We were doing life-saving surgeries like appendectomies, C-sections and amputations in a canvas tent. We had a small 35-bed inpatient hospital for patients suffering from malaria, kala azar [a parasitic disease that attacks the immune system], typhoid, diarrheal diseases and other tropical infections, or war-inflicted trauma such as gun shot wounds, stabbings, etc.”
“In Somalia,” she explains, “we couldn’t move freely in the community. We were accepted there as health professionals, but that’s it. Beyond that, acceptance was in short supply. This meant that our movements were between the health centre and our compound and back again. This was unusual, but MSF gave us one week off for every six weeks on. It was understood that the conditions were quite extreme and field workers were tiring easily in this context. When you have to live with the people you work with, it can become a very small world. It kind of just made everything more extreme.”
Skills and education required
To work on the medical side of a humanitarian aid mission, having the necessary qualifications in your speciality (medical, nursing, therapy, public health etc.) is just the beginning. Some agencies require a minimum of two years’ experience in your field of competency, as well as experience that demonstrates your ability to live and work in a different cultural and geographic setting.
Owen Campbell, a Human Resources Manager with MSF says, “prior experience in leadership positions, training, coaching and supervisory positions is important. MSF field workers will need clinical and hands-on competencies but their main role will be as people managers and coordinators of activities.” He adds, “Tropical medicine degrees or diplomas are considered assets, but having them is not a 100 per cent must. What holds more weight is actual experience volunteering or working in low resource settings outside the Global North. Someone who has already done some humanitarian work, no matter how short, is well regarded.”
Other skills that are valued include: a working knowledge of multiple languages (Arabic is especially in demand), experience teaching—and also, the requisite soft skills (communication, coping with stress, teamwork, tolerance), that will help you cope with the challenges of working in a challenging and unfamiliar environment.
Work in the health care sector abroad
Working on a humanitarian aid mission in a developing country, in a high-pressure, high-risk, conflict or disaster zone is not for everyone, and those who do, must be prepared to cope with a variety of challenges, from working with minimal or rudimentary equipment, to living in unstable, sometimes dangerous environments, to maintaining healthy peer-to-peer and professional relationships while living in close quarters for extended periods of time.
For those who wish to experience living abroad and practising their skills in another country, but are uncertain about their tolerance for the sorts of conditions they might experience in a humanitarian relief scenario, there are many international opportunities in health and medicine in the health care sector in more stable environments.
Global Health
Of course, not all international health and medical work is conducted in crisis situations. There is much ongoing work being done worldwide to address healthcare challenges and inequalities, predominantly in low- and middle-income countries. Organizations—NGOs, foundations like the Gates Foundation, bi- and multilateral organizations like the World Health Organization—require healthcare professionals for development and rehabilitation programs.
Overseas assignments can sometimes involve clinical care—acting as an extra pair of hands or filling in where there are staff shortages or bringing specialist skills where they are lacking. But, in recent years, the trend is away from organizations providing medical care directly, and more geared toward helping local healthcare systems strengthen their own capacity to manage health issues in their communities. It is more likely that healthcare professionals will be recruited for roles that involve teaching, knowledge transfer, advocacy, research, or as consultants and advisors.
Assignments can range in length from several months to a year or more and can involve jobs like organizing services, managing projects, training local staff and working with local partners and communities.
Dr. William Cherniak is a physician, and the Executive Director and Cofounder of Bridge to Health Medical and Dental, a Canadian humanitarian organization working with local health care professionals in East Africa to treat patients and build sustainable solutions to long term medical care.
“When I go to Uganda,” he says, “I do practice medicine – I see patients, treat medical conditions, but it’s interesting because my favourite aspect of my work is partnering with the Ugandan healthcare officers (the equivalent of nurse practitioners in Canada) seeing patients together, and teaching them. I definitely see myself as a clinician, but my main role is to organize the teams, organize logistics, and ensure the health camps are functioning. At the end of the day, we’ll have seen 1,000 people at the camp. To me, that’s what it’s about. As a clinician, I could not treat 1,000 people alone.
“Global health is inter-disciplinary and inter-professional,” he adds. In order to attack a problem like healthcare, it’s vital to incorporate everything: environmental health, legal health, medical health – all of these various factors are interplaying.
Dr. Rohit Ramchandani, an adjunct assistant professor at University of Waterloo’s School of Public Health & Health Systems and the CEO of Antara Global Health Advisors, a global health advisory firm, says much of his work involves connecting networks and teams of experts in order to solve public health challenges.
For example, in many remote, low-resource regions of the world, children die needlessly from severe dehydration caused by diarrhoea. One project he is currently working on ,with an organization called ColaLife, involves using private sector, commercial-style supply networks—the kind that puts soft drinks on shelves in even the most isolated locations—to distribute an easy-to-use, over-the-counter rehydration kit that they have designed.
In his work, Ramchandani says that, research skills are very important—research design, data collection, scientific and persuasive writing, public speaking and presentation skills, and the ability to use evidence effectively. “More and more, you'll need to be able to speak the language of multiple sectors,” he says. “Knowledge of epidemiology, biostatistics, social & behavioural sciences and anthropology is also important.”
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