EP. 37: CONFRONTING INHUMANITY THROUGH MEDICINE

Nov 16

WITH CHRISTOS CHRISTOU, MD

The International president of Médecines Sans Frontières shares stories of hope amid caring for vulnerable patients in conflict zones around the world.

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Episode Summary

When it comes to medical humanitarianism, there is no bigger name than Médecins Sans Frontières (MSF), also known in English as Doctors Without Borders. MSF is renowned for its work in regions affected by armed conflict, endemic diseases, and natural disasters. In this episode, we are joined by Dr. Christos Christou, a Greek surgeon who has served as the international president of MSF since 2019. As a field doctor, he has worked in South Sudan, Iraq, Cameroon, and various other conflict zones. Over the course of our conversation, Dr. Christou takes us into the trenches of his medical work in caring for some of the most vulnerable people in the world, shares how he finds meaning and hope amid the depths of human suffering, and discusses the challenges to global health today.

Born in Trikala, a small town in central Greece, Dr. Christos Christou graduated from Aristotle University’s medical school in Thessaloniki, Greece, and holds a PhD in surgery from the Kapodestrian University of Athens. He also holds a master's degree in international health with a focus in health crisis management from the University of Athens and is a member of its faculty.
Dr. Christou specialized in general and emergency surgery in the Surgical and Transplant Unit of Evangelismos Hospital in Athens. In 2013, he moved to London, where he was a senior clinical fellow in colorectal surgery at King’s College Hospital. In 2018, he became consultant of colorectal and emergency surgery at North Middlesex University Hospital. The same year he was awarded a fellowship from the European Board of Surgery in Coloproctology.
Dr. Christou joined MSF in 2002 and has since held several roles. His first assignment was in Greece as a field doctor, working with migrants and refugees. He then worked as a doctor in an HIV/AIDS project in Zambia in 2004 and 2005. After a break from international work, during which he trained as a surgeon, Dr. Christou re-joined MSF in 2013 for assignments in a number of conflict zones and insecure contexts, including South Sudan, Iraq, and, most recently, Cameroon, as an emergency and trauma surgeon. Since 2005 he has served as general secretary, vice-president, and finally president of MSF Greece's Board of Directors. He was elected MSF's international president in June 2019.
In this episode, you will hear about:
• How the values of his self-described “rustic” childhood led Dr. Christou into medicine - 2:28
• How Dr. Christou’s time in university shaped his life philosophy - 3:27
• The history and mission of Médecins Sans Frontières/Doctors Without Borders - 5:59
• What it is like to practice medicine in regions affected by armed conflict and natural disasters - 8:13
• Dr. Christou’s journey in MSF, from when he first heard of it to how he became its leader - 10:42
• Lessons learned on finding meaning in medicine in some of the most resource-limited settings - 13:41
• Dr. Christou’s stories of inspiring hope in patients even during incredibly challenging times - 16:19
• A discussion of the dangers faced by clinicians who work with MSF - 19:54
• The significance of bearing witness to suffering in giving a voice to vulnerable patients - 23:11
• A discussion of the major threats to global health today: climate change, epidemics, and war - 26:25
• Advice for new clinicians who wish to tackle issues in global health - 30:00
Henry Bair: [00:00:00] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:03] And you're listening to the Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build health care institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:19] In seeking answers to these questions, we meet with deep thinkers working across health care, from doctors and nurses to patients and health care executives. Those who have collected a career's worth of hard earned wisdom probing the moral heart that beats in the court of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:00:44] When it comes to international humanitarianism in the form of medical aid, there is perhaps no bigger name than Médecins Sans Frontières, commonly referred to by its acronym, MSF. Known as Doctors Without Borders in English, MSF is renowned for its work in regions affected by armed conflict, endemic diseases and natural disasters. In this episode, we are honored to be joined by Dr. Christos Christou, a Greek surgeon who was the international president of MSF as a field doctor. He has worked in South Sudan, Iraq, Cameroon, and various other conflict zones. Over the course of our conversation, Dr. Christou takes us into the trenches of caring for some of the most vulnerable people in the world, shares how he finds meaning and hope amidst the depths of human suffering, and discusses the challenges to global health today. Christos, thank you so much for taking the time to join us and welcome to the show.
Christos Christou: [00:01:26] Thank you for having me.
Henry Bair: [00:01:27] We are so excited to have you with us as our first clinician not based in the United States. And whom better to speak with about international medicine than yourself? I have heard of MSF since I was a child, and growing up in Taiwan, I always had this idea of MSF as this ultimate symbol of a great love for humanity and of personal sacrifice. Before we get into what MSF does and how you got involved, can you tell us what first drew you to a medical career?
Christos Christou: [00:01:51] Well, I always wanted to become a doctor. I always wanted to become someone who could help others. And if I look back at my family's history, my father was a mathematician, my mother was a seamstress. But they both came from very poor families. And to them, what mattered more than money or success was to come out of this poverty by helping others and also by gaining knowledge, by studying. And that's what they also taught to me. I have to say now that it was one way for me to move out of this and medicine was a very good option. And that's how I started. I tried hard and I joined the university back in the late nineties.
Henry Bair: [00:02:26] As you look back, what were some of the most impactful life decisions and experiences that have shaped the arc of your work?
Christos Christou: [00:02:33] It was those years in the university and especially those years in the amphitheaters, trying to understand my decision to get more familiar with medical ethics, but also to look at the societies outside, how we can better make use of what we are studying here, how we can help others, how we can help the whole society to thrive. Because it's more than just helping people and fixing their own problems, their health problems. So these were quite impactful moments for me. The interaction I had with other colleagues of mine, the medical students, students from other faculty schools, that I was a big, big university there. And we could see that we all one day will come out in our society. We want to contribute and we want to do it by complementing each other. And these are memories that always help me reminding why we are here for. Of course, in the late years of my medical studies, we were doing the practices in our hospitals and they are even just taking the blood pressure of a patient was such a feeling. The very early days of my career. I will never forget how people always look at you when you're there to hold their hand and make them feel better that, yes, we are here to help you. And I think that this was always a moment that can never failed in your life and in your memories.
Tyler Johnson: [00:03:39] Christos, can I- Can I just back up for one second? You know, I realized over the years that people who trained to be doctors in the United States tend to make the assumption that the path from high school, what we call high school to becoming a doctor, is the same everywhere in the world. But of course it's not. Can you just walk our listeners through how did you get from point A to point B? So you finished your high school when you were around 18, and then what were the steps from there leading you to become a doctor?
Christos Christou: [00:04:00] Indeed, I finished my high school when I was 18 and then I had to drive through a system that is national exams in my country and I didn't pass the first year. I had to get them again next year. So that's how I joined the university. The university studies, there are six years and in the last two years what you also do a lot of clinical practice and then you have not to automatically become a doctor. Having graduated in medical school, that's when everything starts. And actually you had a mandatory course of almost two years to practice something that we call general practitioner or family doctor services in rural areas, places, remote areas in my country. I come from Greece, as I said, but I see that this must be also a system, more or less in several other Mediterranean countries in Europe. But to your question also about the memories, these are the memories that I will always carry, because these were the very first years of my career as a doctor, an amazing experience, no matter if I could offer them much or not, because I was still in my very early years. But being there, standing by them, it was something that I will never forget.
Henry Bair: [00:04:57] I know that you are trained as a surgeon, which of course, is just one of many different forms that a medical career can take. Can you share with us what in particular drew you to surgery?
Christos Christou: [00:05:07] I haven't finished with this mandatory course of two years. In remote areas, I started understanding that there are different pathways in front of me. Like I could do internal medicine, I could do lab, I could do. Psychiatry was also something that, especially in Greece, those years, it was a kind of trend. It was a mainstream for our doctors to get more familiar with psychiatry. But I wanted to become a surgeon because I always felt like it's one of these what we call very clean disciplines, something that you see the impact immediately that sometimes you don't offer that much in terms of medication or advices, but you have your hands and you can really fix a problem or save their lives. And that's what fascinated me.
Tyler Johnson: [00:05:43] I realized over the time that the difference between me and surgeons is that surgeons look at surgery and think, Oh my gosh, look at all the good that I can do. Immediately I look at surgery and think, Oh my gosh, look at all of the bad things that I could do immediately if I were in charge. So that's why you're a surgeon and I'm not.
Christos Christou: [00:05:57] That's true. That's. That's so true. Yeah.
Tyler Johnson: [00:05:59] So now switching gears a little bit, as Henry said at the get go, you are helping to lead possibly the most famous international doctors organization. Right. Which I think most even early medical students have probably at least heard of. Doctors Without Borders. I'm not even going to try to say the name in French, because when I try to say things in French, people all over France start vomiting. So I'm not even going to try that. But I would like it if you could just give us a little bit of an idea of two things. One is what is the history of MSF? Where did it come from? How did it come into being and what does it do right now? Like what are your organization's main points of focus currently?
Christos Christou: [00:06:31] So our organization: Médecins Sans Frontières - and it took me a while to pronounce that in French - started in 1971 with a group of doctors and some journalists, and their mandate was not just to deliver humanitarian aid to those most in need, but also become somehow the voices of the people that we were treating to bear the witness of their problems. That's why our mandate is humanitarian action and also what we call advocacy bearing witness of people's problems. Since 1971, we grew up a lot. The last ten years especially, we almost doubled in size. Now we are an organization that has more than 65,000 people working in the different missions, and we are present in more than 72 countries. And I don't count our presence in countries like even the United States or France, Belgium, the times of COVID pandemic. Because in these places we couldn't even imagine that we would found ourselves in such places. But we understood that there were many challenges and problems all over the world related to the pandemic. Our main focus is in addressing diseases, outbreaks, epidemics, treating malnutrition, people responding to natural disasters or manmade disasters like conflicts like the wars. We can talk hours about the different, let's say, context and how different is each one of them, no matter if they all belong in the same category of being conflicts or being natural disasters or epidemics. And we see how they all intersect, how one overlaps the other, and how in places where you have a protracted conflict or a situation like this, you also see the outbreak of diseases or you see how the immune system of the society is being affected. So these are roughly the main areas of where we work, and this is what we will keep doing, which to me makes absolute sense that we are there as a medical humanitarian emergency response organization trying to address needs that most probably have not been addressed by others, or the problem is much bigger than what maybe other organizations could respond to.
Tyler Johnson: [00:08:13] You know, one of the things that I think makes what you all do different from what we all do is that when I go in to practice medicine, everything I do is in an incredibly carefully controlled environment. The temperature is controlled, the humidity is controlled, the hygiene is controlled. There are plenty of resources for everything I need all the time, right? Like I remember when the when the pandemic was starting, it got to the point where we were getting weekly emails from the supply chain management division of Stanford just to reassure us that we were going to have enough masks and enough gowns and enough whatever of all of the things that we need. And yet, when you guys are out practicing, you have none of that, right? Or you have whatever you have. Maybe sometimes you have some protective gear or whatever, but often you don't. And even beyond that, sometimes you're literally practicing medicine in a war zone or just barely removed from a war zone. Right. Sort of just behind the front lines. So can you talk a little bit about what goes on in your heart and mind to prepare yourself to practice medicine in a place that actually does pose a significant risk to your own life and limb?
Christos Christou: [00:09:14] Yes, that's exactly one of the main priorities for my organization and for each one of us that we join this organization. We join a mission to understand exactly how unprecedented this can be, how challenging could be in terms of our safety and the risk that we may take in many places. And actually, the risk, of course, is also the challenges that we face when we have to apply medicine in what we call very limited resource settings, like in places where I myself as a surgeon have been several times and being asked to perform a major operations like an exploratory laparotomy in an inflatable tent. And that was a common practice in nine places like in South Sudan and which have been twice so far. And not just because I really enjoy practicing surgery in inflatable tents, but because the needs are great. We need to be there with any of the means and the materials we have. But back to your question about the risk taking. It's one of the things that although we try always to make very clear to our people and gain an informed consent by them on how this is going to look like and how maybe they may put even their lives in risk, we realize that this is not enough. And the people, of course, want to join us. They want to be in these places and we have to keep updating them on the situation that contains every time. And we have to be constantly on top of the things and in position to really evacuate the people from a context when it comes really out of control. So it's not a one stop thing that you made a deal with people that they join you and they come with you in a mission. It is constantly a challenge, It's always a problem, and we have to reassess security in all almost all of our contexts every day.
Henry Bair: [00:10:42] I'd like to take this conversation back to a more personal level. Christos, can you tell us how you first got involved in MSF and how you came to be its leader?
Christos Christou: [00:10:51] But let me start by saying, how did I first know MSF and what made me join MSF? Because I need to drive you back again to my years in medicine, the medical school. One day I remember I saw a poster that really hypnotized me. It was a bullet on top and a tablet of medicine below it, and it said "their weapons kill hours, save lives" and asking for medical people and not only to join MSF in their missions. And that's what I wanted to do. So I started by providing some medical support to refugees and migrants coming from Middle East. Those days that there was a war also in Iraq. And later I found myself treating HIV AIDS patients in sub-Saharan Africa. It was at the beginning of 2000. It was a big, big challenge for the whole medical society those days all over the world to really help those people. We had the first the very first line of antiretrovirals. We knew that they were effective, but at the same time, they were not that safe and they were coming with many, many side effects. So it was a battle also for MSF to prove to everyone that no matter if people do not have horses or all the facilities to comply with such treatments, as long as they they know what they are suffering from and what we are offering to them can help. They will really support themselves. And this is what happened back in early 2000 with HIV. It was a game changer. People really complied with their treatment. And then it was then with our societies, with our post-test club groups, patient groups that they started advocating, demonstrating for better treatments, for safer treatments, for lower cost treatments.
Christos Christou: [00:12:16] So that was something that really fascinated me with this movement of MSF. And I kept joining missions as a doctor, always a field doctor. Later on I came back in Europe. I continued with my studies. I became a surgeon, as I mentioned before, and then my mission changed. I had to stay shorter period of time, a few weeks and do surgery. So I find myself in places like again, South Sudan, Cameroon and now Yemen. In Syria and Iraq. Mosul, places that we call highly insecure as a context, but places that have been affected by conflicts and providing emergency and trauma surgical care. That was always my relationship, let's say, with with MSF, with Doctors Without Borders. But MSF is more than just a humanitarian organization with its executive body and their operations. We are also a movement, a movement of people. We have associations. What I mean, associations are all these people that they may have joined different operations and then they are back. They are back in their home societies and they want still to engage. They want to be ambassadors of what we do. That's how I joined also this big movement of MSF. I became a president of the board of directors of one of these sections of MSF, Greece, which was a small one, but still one good next step for me to gain this experience. And in 2019 I was elected by the group of the whole movement of MSF as the international President, and I am now in my second term because we have maximum two terms as international presidents and we're not allowed to serve for this in this role more than one day, two or three years.
Tyler Johnson: [00:13:39] Thank you so much for for walking us through that. You know, the most important reason for this podcast is because this may sound sort of foreign to you, but here in the United States, there is a lot of consternation right now about what we call the epidemic of burnout among doctors. So if you look at the percentage of doctors who report that their work has no meaning or that they at least have difficulty figuring out what the meaning is, depending on the survey that you look at, the number is usually at least in the 40% range and sometimes as high as the 60 or 70% range, which we find to be really striking because most people go into medicine with very high minded ideals, right? They have this very sort of clear articulation of the moral and ethical reasons that they want to go into it. And yet at least almost half and maybe a large majority of doctors, at least in the United States, now have difficulty remembering what the meaning is. And so I guess this may sound like a little bit of a funny question, but working in some of the least secure, most impoverished and most difficult areas in the world where you often don't even have all of the sterile instruments that you need, let alone all of the fancy antibiotics and respirators and pressers and other things that we take for granted in the United States. What can you help us here in the United States who practice largely much more comfortably than you do? What can you help us to remember about the meaning of medicine, about why we're here in the first place? What has your international work taught you about that?
Christos Christou: [00:14:52] I think the way you put the question is very good. That helps me to remind both to our audience, but also to myself. What is this that makes the difference? As you said, of course, it's always important to have advanced, sophisticated ways of practicing medicine, surgery, whatever is always helpful. And I can see how lucky am I to live in such an environment where all these are available and we have all these very highly trained people to offer the services. However, at the same time, is not this in the core of both our question and the answer? The course would be the patients and the relations we have with the patients. When you miss that, when you lose that, when this is getting blurred or diluted, then that may make you also feel a little bit discouraged or to withdraw from from from medicine. I think in all these places that I have been, what kept me vital and really boosted my morale. I remember that so many times. We were also stretched and we didn't know even how to cope with the stress. When you you feel insecure, but you also feel so, so sad and so shocked with what you see around and with the pain, the human suffering at the end. What? Keeps us. Is this a relationship that we establish with the patients? We stand by them and they pay us back by not just looking at smiling or encouraging us to carry on, but appreciating even the very few things that we are able to give to them. And that is what my opinion makes the big difference. And I can go more into details later if the time allows. Also, one might reminds them of some stories that I had that I always carry. I hope this could help also the others, but it definitely helps me to keep doing what I do.
Tyler Johnson: [00:16:19] So that was my next question. I was hoping you mentioned this paradox that I think is integral to the practice of medicine, which is being in a place with a patient where you can't fix things, you can't cure them, right? Or in your case, you may not. You might even know something that could, in theory, cure them, but you don't have access to all the resources that you need. And there's this suffering that you can't entirely fix. And yet you're able to find meaning in the midst of that inability to do everything that you would like to do. Could you tell us a specific story about a time when you faced that, a time that you faced great suffering? That was very difficult. You couldn't do everything that you wanted in terms of fixing the problem, and yet you still found meaning nonetheless.
Christos Christou: [00:16:56] I have in my mind two stories. The one I was last year when I went back to South Sudan and I joined one of our missions in a camp, a huge camp of Hundreds of thousands of people there. We call them protection of civilian camps. And MSF was there with a kind of secondary hospital unit. Those days, it was also very, very unsafe, very insecure. Every night I had to operate on gunshot wound patients. And I remember that they called me one night. I walked into the air department that we had set up and everything you can imagine looked like tents and a very basic settlement there. But still, I saw a patient that had a complete isolation because of a huge trauma on his abdomen. And I knew that we have only one blood unit, no intensive care unit, one anesthetist who could do that with ketamine. There was no option for intubation there. And I felt like, okay, why are we losing our time now? And when I was thinking about that, I looked at his eyes and he was looking at me. He was still alive and he couldn't even talk. He was holding all his intestines here. And then he had two of his friends helping him. And it was like, okay, let's let's do it.
Christos Christou: [00:18:05] Let's do it together. And we see whatever. So we went to theater. We have the theater. We have a theater which, as I said before, had the basics. I had a diet for me. I had my sutures. I had all the basic things to start fixing a few of the holes in the bubble. And now then I realized that there was no major trauma, vascular trauma. We ended up after a few hours with closing the abdomen, and we didn't have an ICU, but we all stayed there with seats to support him for a couple of hours. And next day he was doing a bit better and to cut it throat. After a few days he was about to be discharged. And it was also the days that I was handing over to another of my colleagues. I could never believe that we could save this patient. So sometimes it's them that they help you to help them. And that's where we get all this from. And what we should never lose is hope. And now this brings me to my second story, which goes back to my very first years with MSF. When I said before that I was in sub-Saharan Africa trying for three days, I'd be patient. And we said how important was for them to comply with the treatment? The antiretrovirals.
Christos Christou: [00:19:02] You miss some doses. You may cause more harm than good to these patients and you may develop resistance. So one of them one day came to the clinic and the nurse asked me to go and see him because he stopped. He refused to continue his treatment. So I went there to find out what's going on. And he said to me, I stopped because I heard that you're about to leave. I said, Yes, I'm leaving soon after ten months, but you need to carry on. It helped you so much and you see that it's very effective. So you know that this is how it goes. Someone else will come and replace me. Where also I want to see my family. We are all humans. And he said, No, no, no, Doctor, you are not the human. You are my hope, you are my prayer. And that means a lot to us these days that we recall the sad stories about keeping the hope alive because treating humans with dignity and this right to stand by them and to help in their pain. Maybe at the end of the day, what we do more than anything else is keeping their hope alive.
Henry Bair: [00:19:54] Those are really powerful stories. Some people might hear that and think, "Yes, I'm sold. Those stories are why I chose medicine. Sign me up." At the same time, I'm sure that many people, after reflecting on what MSF actually does, will be unable to get past the thought of putting oneself at the most acute form of personal risk. Say you are operating in a tent somewhere and there are bullets flying just outside and people are dying around you. Perhaps your colleagues have already been subjected to the violence endemic in the area. Many might look at that and think, "Yes, I love medicine, but how can I do good medical work when my safety is constantly being threatened?" In my case, early on in medical school, I remember once bringing up my interest in MSF with my parents, who very quickly begged me to drop the idea. Not that they didn't respect or value what MSF does, but rather they simply could not bear to imagine me working in such dangerous situations. I'm sure that even for those in MSF who are already working on the ground, these concerns are somewhere in the back of their minds. Is this something you have wrestled with, and if so, how did you deal with that?
Christos Christou: [00:20:53] All these bodies are very legitimate. Now, maybe we have created some kind of myths around the work in MSF, and I really wouldn't like to come out from this podcast with this impression that we are the heroes, that we really care about our own lives, we just care about others. Patient safety is always a priority, but also the care and safety comes first in many places still today. We cannot access because of security reasons and we would like to do more. We would like to be closer to more populations that they are excluded. But as long as they are in the middle of a conflict and there are no what we call humanitarian space or humanitarian corridors for us, we try not to go. Having said that, though, we have during all this 750 years since the inception of MSK, we have lost plenty of our people. They had either been abducted or killed in conflicts, and that's why we try these days even harder, not just to understand and analyze this context, but make sure that went to enough safety for our missions to operate. But even if it is safe enough for us. Very recently I was in Ukraine and the places where we developed our activities were not in the very, very front line.
Christos Christou: [00:21:56] Still, you see the shelling. You can hear the bombs as you can look next to you and see that something has been bombed now. And there, of course, I understand that all my colleagues and everyone who is in this humanitarian war may have experienced stress, but it's not easy even to describe to others. We do have services like psychological support. But again, I'll come back to what helped me more than anything else is to share this with my people, but also to share this with my patients. In some cases I hear them saying that as you protected me and saved me, now it's my turn and my community will do their best to protect you guys, that you came here to assist us. And sometimes it's them that we become our seal and not seal that I can protect you from the bombs, but don't feel that can protect you from narratives against the humanitarianism or the hostility of different non-state armed groups or even state armed groups. When there is a conflict, it is again the community, it is the patients and are people that matter a lot.
Tyler Johnson: [00:22:50] I just I just want to go on the record saying that for all of the things that you said that have inspired me, the one thing I definitely disagree with you is about whether you guys are heroes or not.
Christos Christou: [00:22:58] I think the idea of the heroes is like, you're going to go now to your hospital again and now you see how they struggle there to alleviate their suffering. And we are there to to help. But the big battle is always been given by them.
Tyler Johnson: [00:23:11] I have to imagine. So you mentioned early on that your hope in every case, of course, is to bring healing. It's to fix the problem, cure the disease when possible. But even when you're not doing that, you use the word witness. You said that you are you all are there to witness the suffering of your of your patients and then to bear witness to that suffering in the media or in front of governments or whatever when necessary. We have heard some other doctors in very different contexts share similar sentiments. But I have come to recognize in my life, which is much, much, much more comfortable and much easier than yours, especially in terms of the way that I practice medicine. But even in comfortable confines, the weight of bearing witness is significant. It's a lot, right, to to to be a witness to human suffering. And so I guess I wonder how do you personally equip yourself to be able to do that and not have the weight grow so heavy that it becomes unmanageable that it becomes toxic or dangerous to you? What buoys you up in the dark hours of the night or the times when hope threatens to flee?
Christos Christou: [00:24:08] Well, that's a great question, because indeed, I now recall all the challenges that we have been facing on these last years to bear the witness and now talk about what we see to become the voices of those that we are there for. And there are several challenges, but I think simplicity could be part of the answer to this question. And simplicity comes with telling it as it is. So what we see or what we bear as a witness, or what we hear from their own mouths is what we tell and what we say with the others. And also maybe not enough. But when this comes with our independence, our impartiality, our spirit of neutrality, those main driving principles that we have, it can make a good combination and it can come with a very, let's say, true story that people will listen to a story that does not want to become part of a noise that. It's already a story that comes straight from the mouth of the people. But I don't think we always have the right recipe. Maybe we still struggle to find the most appropriate ways to do that. Maybe sometimes by using the stories of these people, and especially when this is accompanied also with an image of them, no matter if you have gained their consent or not.
Christos Christou: [00:25:12] Maybe this is not enough and maybe ethically is not the right thing. Would you do the same back in your own country with your own patients or not? These are the things that keep me awake some nights, and I understand that many times it is them. It is the people like the one that I mentioned before, before he was about to discharge, to be discharged. He asked me, How can you make sure that others know what we are suffering from here? And at the same time, he asked me also, how can I thank all those that they are behind us and they support us to support these people. But the question about becoming his voice was also addressed by him, and I didn't have the right answer. I didn't want to just say that and then understand that it was just I was a part of the noise that exists already. But I didn't want to also break the medical ethics and using appropriate ways to shock the people with his story. I had to find a good balance, and that's not always easy.
Henry Bair: [00:26:04] I think what you've said about bearing witness to suffering really resonates with one of the core missions of our show, which is to share the power of storytelling to help us slow down and develop a mindfulness for the moments of beauty and tenderness amid the noise of our daily business. And I don't mean just in a medical context either, although as clinicians, we do have a unique privilege of being with people at some of their most human moments.
Henry Bair: [00:26:25] I'd like to change gears and talk about global health at large. Although we arguably live in the most peaceful and prosperous era of human history, with advancements in technology and medicine and standards of living, it is undeniable that there are still massive issues occurring all around us. Political and military strife stands in the way of your work and the work of other humanitarian NGOs. Can you share with us what to you are some of the most pressing challenges to global health now?
Christos Christou: [00:26:50] Well, that's a good question. So bear with me, because I would start drawing a picture for you, which will somehow talk a lot about the challenges. Also with the caveat that this comes from my humanitarian background, maybe my my understanding of other global health priorities is not the optimal. However, I would start with a bigger, bigger threat, which is the climate change we see, and we will continue to see the health impacts of climate change in our programs and our activities and in all places where we work in several ways. Ultimately, we see much displacement, we see malnutrition, we see lack of access to safe water and sanitation. And we see in a nutshell, that those that are less responsible for this climate degradation are also those that they are mostly affected. And next to these, we see epidemics and outbreaks. And I think that we will continue to face challenges from epidemics, outbreaks and the lack of access to medicines and tools to respond to those outbreaks. And particularly I mentioned before, infectious diseases such as HIV and tuberculosis. We still have multidrug resistant tuberculosis and there's not much moving forward with the research and development of new drugs by the global health community. It was MSF that very recently produced a new molecule for multidrug resistant tuberculosis, and after 100 years, I think that was we should go for more.
Christos Christou: [00:28:00] We should think bigger than what we can deliver as MSF. Affordable access to medicines and medical products again. The COVID 19 pandemic should have been a wake up call to all our global leaders and the leaders of industry. It could be an opportunity to show that global problems can have global solutions, but unfortunately, instead of that, we have more or less the same business model which prioritize the people in mostly wealthy countries and ignored also very serious health risks we had in other places in the world. So I hope that next time and while these days everyone is getting prepared for the next pandemic and how to respond, let us not forget that this is still ongoing and let us try to really literally learn from our mistakes. Conflicts. Unfortunately, even during the pandemic, the pandemic itself did not evaporate all other conflicts that were happening in the world. So it's a lot about working in all these extremely complex conflict zones like Ukraine these days Yemen, Democratic Republic of Congo, Nigeria, Syria, Cameroon. These are places that I'm afraid that the situation is not going to be resolved soon.
Christos Christou: [00:28:59] From the other side, I see more and more new conflicts popping up. We see more people on the move, people migrating, people that they look for. Safety is not as it used to be, maybe 30 or 40 years ago. And this time, people really take so high risks putting in the risk both of themselves and their families and their little kids, because they look for safety. And they and I know I know where they come from. I've been there. Even our hospitals have been bombed into such places. So I understand. What does it mean for them to seek a safer place and flee from these wars? So these are roughly some of the main challenges that we have in these challenges. If you look at organizations like mine or all those that are they are humanitarians. Unfortunately, we see that our humanitarian space is sitting more and more and we struggle to gain access to all these populations. And it's getting even more difficult than maybe before to have access or to let these populations reach us. So for me, within this very hostile humanitarian environment, accessing the people that they need you more or letting them reach you is the number one challenge that we face.
Henry Bair: [00:30:00] As we near the end of our time together. I would like to ask you, what advice do you have for clinicians? And I refer to medical students, young career clinicians, nurses and other health professionals. What advice do you have for those who are already interested in global health about tackling the challenges you've laid out for us, and what might you say to encourage more people to think about how they might play a part in addressing these issues?
Christos Christou: [00:30:23] First of all, they have all made a great choice in their life to become doctors, to practice medicine, to help other people. And this is this is amazing. It will have several tough moments, several challenges, but also great, great moments. It will pay them back. I can tell that with all my experience all these years, dealing with the global health issues doesn't necessarily mean that you need to be present in all those places that we described before. You can still do your part and play your role even from your little cabinet wherever you are sitting in an outpatient department in your hospital. As long as you are connected and you understand that the whole world is connected. So what do you do with your patient? Whenever and whatever and whatever is it? It matters a lot because you are a part of a global network of people that they try to assist others. And this is, to me, the global health. And of course, getting experiences of how the world looks like from completely different contexts. Please, you're more than welcome to join organizations like mine, like Doctors Without Borders. But this will not make you a hero. And this will not mean that you will save the world. What it means is that you will offer a lot and your little thing in something big that we all try to build up together. And this is my my main advice to everybody. And when we find ourselves to sometimes that we may not offer enough to those that we are there for. When we find ourselves through those situations where you don't have all the means, you don't have all the medication, what still matters a lot is to keep standing by the people that they need you to keep standing by the patients and holding their hands. And believe me, this is a lot.
Henry Bair: [00:32:01] This is all of those encouraging, inspiring words. I want to thank you for your time and for sharing all of your incredible stories and insights.
Christos Christou: [00:32:09] Thank you so much. From my side. I really enjoyed this.
Henry Bair: [00:32:13] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program, notes and transcripts of all episodes at The Doctors. If you enjoyed the episode, please subscribe, rate and review our show available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.
Tyler Johnson: [00:32:26] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show. Feel free to leave a suggestion in the comments.
Henry Bair: [00:32:40] I'm Henry Bair.
Tyler Johnson: [00:32:41] -- and I'm Tyler Johnson. We hope you can join us next time. Until then, be well.