Mokaf

Mokaf has been a nurse for around 10 years but had originally wanted to become a doctor. In France, you need to pass an exam at the end of the first year to qualify for the full program, and although she had a high mark in the exam, only a certain percentage of people could get through nationally. Begrudgingly at first, she decided to train as a nurse and soon began to enjoy it. Whilst she was still a nursing student, she began an apprenticeship in the A&E department, and this meant that she was able to get a job in an A&E department immediately after nursing school.

She worked for 4 years in Libourne, southwest France, gaining experience in all the different departments of the A&E: ICU, ITU, outpatients, rapid response (paramedics?), and triage. Eventually, she felt frustrated at the lack of further training opportunities, so she left her position at the hospital, explaining that there is the option in France to ask your employer to hold your job for 10 years. She found a job in Saint-Laurent-du-Maroni, a commune of French Guiana surrounded by rainforest, and quickly discovered that during her shift, she was the most experienced member of staff. She told me that in French Guiana she learnt that she “knew something,” as everyone was asking her for advice. She described regularly going out into the rainforest in the truck, where there was no phone signal, and people spoke local, indigenous languages and didn’t understand French.

After working in French Guiana, she went to French Polynesia where she was based on a small island with a circumference of 10km and a population of 1000. There were two nurses and one doctor, so she learnt to only contact the doctor when absolutely necessary as they needed to preserve their energy when not on shift. There she said she “grew up in another way” as she had to deal with “general stuff,” with pregnant women, babies, the elderly population, as well as taking inventories of medication and other more administrative tasks.

After 6 months, she moved to a larger island with a hospital, but only a 2-bed ICU. If a patient required more support, such as intubation, they would be sent to Tahiti. At her new hospital, she took charge of the ICU night shift, as again she was one of the most experienced nurses, and many of the other nurses didn’t have experience in A&E. Suddenly, the pandemic arrived, and she moved from ICU to ICU throughout French Polynesia and eventually to Marseilles, working in ICU assisting with heart transplants. She enjoyed this role as her real passion was emergency, and ICU was more about details. Working with transplants in ICU was a mixture of both. Again, she found herself in a role with less experienced nurses, and she had been given the role as she was an experienced ICU & A&E nurse, and she could support the newer nurses to become autonomous faster.

Following her time in ICU in Marseille, she started working with MSF and was sent to Baghdad to run the A&E & ICU in the non-COVID hospital. She explained that with MSF, you are either sent to an MSF-managed hospital or as a staff member to a local hospital, and in Baghdad, she was in the latter. There were only two MSF nurses, and she was in charge of the staff but in a local hospital. She had to decide who to send to the limited ICU provisions, and if they weren’t in ICU, they needed to be checked and monitored very regularly. There was also the added pressure of the other members of staff being unsure how to use the machines, so it was a difficult role.

After this, she re-embarked on a cruise ship, on a slightly easier voyage into the Mediterranean, and had to learn about survival fire drills. The decision-making skills here had a bigger consequence, as if a passenger was too ill to stay aboard, the whole boat would have to turn around and return to land. After this, she worked again for MSF, this time in Bangui, in the Central African Republic, where she was in charge of IPC – Infection Prevention Control. She found this job less interesting as it was more about hygiene control and less emergency work, which she missed, and after 3 months, she moved on.

After this, she went on another cruise ship, this time with only 72 passengers, which meant there was no legal requirement to have a doctor on board. She was the most responsible medic on board, and by this point in her career, she was very comfortable making decisions about when to request help or declare an emergency. For this role, she also had to train to be a lifeguard.

Her next contract – summer 2023 – was in Chad in a refugee camp for people fleeing the war in Sudan. It was an emergency and surgical tent hospital, built from scratch to care for those wounded in the conflict. One tent was paediatric, and the other was for surgery. She described this experience as “very hard” and explained that alongside the surgery that was needed, in the paediatric tent hospital, there were huge measles outbreaks and infection control measures needed, on top of the widespread malnutrition.

After working in Chad, she again went to work on a cruise ship, the biggest one of her career, which was going to Antarctica. That was where she was when I spoke to her…