Presentation given at the AMEN Australia 2018 annual conference held in Adelaide, Australia, www.amenaustralia.org.

AMEN Australia 2018: Healing, Surviving, Thriving

<p>Presentation given at the AMEN Australia 2018 annual conference held in Adelaide, Australia, www.amenaustralia.org.</p>

<p>Free sharing permitted under the Creative Commons <a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/us/">BY-NC-ND 3.0 (US)</a> license.</p>

Adventist Medical Evangelism Network Australia

Carina Cotaru

Compassion, Fatigue Mission Report

I was meant to be talking about compassion fatigue, but I've already presented about this topic a few years ago, and I couldn't really find a new perspective.

But I was trying to think about the last time that I underwent compassion fatigue.

And It was actually about July of last year.

I'd just come back to work after being away for 6 weeks.

And you'd think that being away for 6 weeks, you would be refreshed and ready to face the demands of working in a challenging environment and that my compassion tank would be at its fullest.

But I hadn't actually just been on holidays for 6 weeks.

I'd actually spent 3 of those weeks in Niger working at a mission hospital called Gawmy Hospital.

And I'm going to tell you how I ended up there shortly, but let me just tell you a bit about this incident that happened while I was on call.

I had a very experienced but unaccredited registrar working with me in the hospital, and I was at home, and she rang me to discuss the patient who wanted to discharge herself against medical advice, and she was unhappy with the fact that she was in a shared room.

She was a gynecology patient, and she actually had to share the room with a woman who'd just had a baby.

She'd only had some minor surgery, but she had a catheter and that needed to stay in for a couple of days.

And so that meant that she needed to stay in hospital for a few days.

And thankfully I was at home and not in front of the patient, because I think for at that point in time, I had absolutely no compassion for her.

And these were the things that actually went through my head and actually verbalized to my registrar as well.

She had a clean bed with sheets to sleep on, she only had to share her room with 1 other adult and a baby, She had 5 meals provided for her for free.

She had nursing staff to care for her while in hospital, and she didn't need to bring a relative with her to look after her.

Her operation had been performed in a timely manner by a highly qualified surgeon, and she didn't have any out-of-pocket costs, and the cost of her travel from a remote community had also been paid for.

And I just couldn't understand how she could demand that she be provided with a single room.

And I think the registrar was somewhat bemused and surprised at my intense reaction and so she very kindly just said, okay, fine, I'll sort it out.

So she offered to find her a bed in another ward and the patient did stay in hospital.

When I put the phone down, I realised that my response was most likely out of proportion and that I was probably suffering from reverse culture shock, something that I hadn't really thought about too much.

And I needed to put into practice strategies to deal with this if I was going to become an effective clinician again back in my home environment.

So given that we've already had a few little talks about mission work, I thought I'd share about my mission journey, how I ended up at Galmi, and some of the decision-making processes that I went through, and you may find some of these tips useful.

So as has been mentioned before, I'm an obstetrician and gynaecologist based at Royal Darwin Hospital.

I've completed most of my training in Sydney and spent my last year of training in Edinburgh in Scotland.

And I'm telling you some of these things just so that you, I guess, get an idea about the journey that God's taken me on to get to the point where I went to Niger last year.

My family immigrated to Australia when I was 12 from Romania and I've lived in 4 countries and travelled to well over 30 countries and I speak several languages.

My great-grandfather was the first person in his village about 90 years ago to accept the gospel and then gave a plot of land away on which he went on to build the first Adventist church in his village.

And growing up in a Christian home I saw many examples of service and combined that with my positive experience of being welcomed into my adopted country, I was always envisaging that through my career, I'd be serving in an area of need.

And given that I have cross-cultural experiences and I love traveling, I presumed that I would be taking mission work overseas in some capacity at some point.

So my first taste of overseas mission work was a trip to Vanuatu with my school in year 11.

I can't actually remember why we were going, but what we actually ended up doing was hiking through several villages over a week.

We spent some time snorkeling and worshipping with the local church on the weekend.

So I don't feel like I actually was very useful, but what it did do for me was it opened my eyes to the conditions in which A large proportion of the world lives and it made me realise again how privileged I was and it also strengthened my resolve that out of the abundance of the blessings that I'd received I was compelled to help those less fortunate.

My next encounter with mission work was during medical school when I read about and met Dr.

Katherine Hamelin, the famous Australian fistula surgeon, who together with her husband Reg established the Addis Ababa Fistula Hospital in Ethiopia.

And this encouraged me to pursue my dream of becoming an obstetrician and gave me rather grandiose ideas about changing the world, or at least that of women less fortunate than myself.

And then as a final year medical student, I spent 5 weeks at Kajabi Hospital in Kenya, where I had a great time socializing with other medical students.

I did quite a lot of sightseeing, but horrifyingly was also left in charge of the medical ward several nights a week with remote supervision by the physicians who were at home.

And I say horrifyingly because I think I only realise now the extent of responsibility that was placed on me.

And I do question the ethics of that, because we would never allow that to happen in Australia.

And it's something that actually still happens in mission hospitals.

Maybe you do have more knowledge than the local nurses, but often you don't.

But this did have this little mission trip did sort of have a positive effect and I still wanted to serve overseas in some capacity.

The reality of daily life as a junior doctor then hit and it was followed by the pressures of applying for a training program, that petrifying first year as a registrar.

And they all took their toll on me, and the idea of serving overseas, while still strong in my mind, took a back seat.

However, at that time I decided to start a Masters of international public health to better prepare myself.

And while I learnt a lot during this time, it also left me rather discouraged and with a lot more questions than it actually answered.

And these are some of the questions that I had.

And I don't know that I actually particularly have answers for them, but I'm sure some of you will be having the same sort of questions, what and where is the best way to serve?

How do I serve in an ethical and an effectively useful way?

For me, it was a matter of how much time could I take out of my training?

How do I choose what organization to serve with?

When's the best time to go in terms of what time I could take off, but also in terms of the skills that I could offer in terms of the impact that would have on my training and other commitments.

So at that time I was in a training program in a hospital which didn't have a strong record for medical missions or where this was particularly encouraged.

So these questions sort of continued to simmer at the back of my mind with no clear answer.

Towards the end of my training, I went on another, or actually 2 short trips to Nepal with a small team of gynecologists and estheticists and nursing staff to perform pelvic floor surgery for 2 weeks for women who otherwise couldn't have afforded this life-changing procedure.

We took along all our equipment, performed surgery, did a little bit of teaching on the way, had a great time as a team, did some sightseeing and then returned to our respective lives in Australia.

And while I acknowledge that we certainly improved the quality of life of many women, this kind of short-term volunteering left me feeling uneasy again.

Were we actually bringing new skills to the country?

There were many trained gynecologists who could perform the procedures we were undertaking, but they were overwhelmed by the need for obstetric service.

And the women needed to pay considerable sums of money, so that made it out of reach for most of them.

Were we reaching the women who were most in need?

And could war women have had surgery, instead of sending such a large team from Australia, if we just donated the money we spent on travel and they could have had local surgeons perform this?

Another question I had was, was it ethical for me to perform these surgeries as a trainee, even with close supervision on unsuspecting patients who didn't know I was a trainee?

And then I had no way of following them up in the short or the long term.

And what were we doing about actually preventing the causes of pelvic organ prolapse and the longer term health of these patients?

I felt that I'd probably gained more from these trips than I had contributed and after 2 trips with these unresolved questions, I decided that this was not a good fit for me.

And I continued to pray and keep an open mind for other opportunities.

And when I say unexpectedly, it was unexpected for me because as far as God was concerned, he'd prepared this move for me.

However, I was oblivious to the ways that he was leading.

And for the first time, I found myself working in a department which was open to my pursuing volunteer work.

And I worked with other consultants who'd spent considerable parts of their careers working overseas, either independently or with Christian organisations or other NGOs.

And so I was able to ask them lots of questions and was able to use them as resources when I eventually did work overseas.

Over the previous 6 to 7 years, I'd kept in touch with a friend who's a GP obstetrician and she ended up working as a missionary doctor in Niger in West Africa.

We'd met up in various places around the world and She kept asking me to go and work with her, and I kept promising that I would go when the right time came.

And that right time came when I actually went to Darwin.

Work agreed to give me leave without pay, which would have been unheard of in Sydney, and a few other opportunities lined up.

And that's how I ended up spending 3 weeks in the middle of last year working at Galmi Hospital which is run by a serving in mission in Niger in West Africa.

Just a little bit about, This was 1 of the verses that I come back to a lot.

And I think my mission, sort of journey, illustrates this, that God knows the plans that he has for our lives, and they're plans that are good for us and good for those around us as well.

So Niger is a landlocked country in West Africa, not to be confused with Nigeria.

It's a Muslim country, formerly colonized by the French.

It's got a population roughly the same size of Australia.

However, when you look at their statistics, particularly in obstetrics, their maternal mortality ratio is 650 per 100, 000 maternity.

So if 100, 000 women give birth, 650 of those will die.

And you compare that with Australia's MMR, which is 6.8.

Only 29% of women have a skilled birth attendant at delivery, and they have a female literacy rate of 35%.

And This is what greeted me as I was landing in Niger.

It looks very different to what Australia looks like.

And I still find it hard to articulate the experiences that I had at GALMI.

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Compassion, Fatigue Mission Report

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