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Um So our next speaker is Doctor Mali and he is in True E D Spirit, A Jack of all Trades and he's going to be doing a talk about MSF. Um He's currently a pediatric, any consultant at the Bristol Royal Hospital for Children, having trained in Cambridge ECL and London. Before moving to Bristol in 2019, he's undertaken a number of missions abroad including um to Myanmar with the Royal College of Pediatrics and then Iraq, Sudan *** and South Sudan with MSF. He also undertakes regular telemedicine cases and is involved with the Global Health BSC at Bristol Uni. Um he did uh drop in a few fun facts about himself as well outside of medicine. Doctor Mali is a diehard wig and rugby league fan. Um His interrelated degree was in history and he specialized in government secret intelligence take from that what you will. However, if that wasn't enough, his biggest claim to fame is that as a 15 year old journalism work experience student, he wrote the first published story in the Western world on the September the 11th terrorist attacks. So without further delay, um Doctor Mali take the take to the floor. Great. Thank you so much. Um Let me just let's hope that this uh this does actually happen. Let's do this. We did, we had like a nice little practice of this a minute ago and it seemed to work well. So fingers crossed. Can someone tell you? They can just see that? Yeah, we can see it. Perfect. Thank you so much. Well, thank you so much for the introduction and thank you very much for having me and well organized to everyone doing this. It sounds like an amazing event. So congratulations. And yes, as you say, my name is Michael and, and I'm just going to talk to you a bit about some experiences with MSF today. I think you've had some global health talk earlier in the morning, which is sort of like wetted appetite for sort of the more public health aspects when you know, the actual kind of the big picture. And so I was going to try to focus this a little bit on just kind of personal experiences in the field and then just talk about sort of pediatrics from that perspective. And just before I get started, I mean, pediatrics lends itself extremely well to global health stuff because there are just Children everywhere. You'll notice you notice this particularly in places like Sainsbury's where I just come back from where you kind of blur it out of your pediatrician, you don't really get there. You don't really hear the crying anymore. But there are Children every where in the world as you'd expect. And as we know that under five mortality is one of the biggest drivers of inequality, uh lack of opportunities in the country and geopolitical conflict unrest and also economic opportunities. Um and just give you context obviously in the UK pediatrics is under 16 and when I was in *** and the median age of the entire population of *** is 14 years old. So there I know what you know what media is, but there are as many people under the age of 14 in the entire population as there are over it and give you some context in the UK. I think that's about 56 in the UK. So you can imagine that over half the population is in pediatric medicine and obviously there are huge health issues there. So pediatrics is a specialty lends itself well, there are huge needs across the world. There are many ways to get into that. I'm going to talk mainly about MSF today if that's okay. So just quickly who are MSF first just cause it's it is pediatrics with MSF that I'm going to talk about. So obviously, medicines on frontier doctors that borders and so huge humanitarian organization. Now, 50 years old, celebrated the 50 year old and anniversary last, last year. Um I was going into a bit of a bay mouth really of, of an NGO with a worldwide community and employees from over 100 and 50 countries. And this is kind of like a little bit of a not propaganda but in a, in a positive way and just saying what MSF are and they're very, very keen on their core principles. And that's actually kind of one of the reasons why I wanted to work with them. So they are fiercely independent and that is good and bad. So you'll, so that independence means that they can pretty much do in some ways what they want, where they want to and they're not beholden to geopolitical entity. So they're not, they don't receive funding, for example, from the U or from the British government or from any sort of big corporations or pharmaceuticals or anything like that. So they don't have to ask anyone else or is it okay if we go here? Are there any political problems, if we go here, they're able to sort of make their own decisions? A lot of time. The slight problem with that is, I think sometimes they're not as quite as well integrated into, into wider humanitarian responses and other people may know more about this than I do from a high level, but I've heard definitely from the W H O cluster meetings in, in sort of emergency settings that MSF are kind of standing in the side of the room and not really saying very much because they, they want to maintain their independence. So it's a little bit of a double edged sword. But I think it's a really important thing. They're obviously also fiercely impartial. So they will treat anyone from any background who has any medical need um in, in any of the locations where they are, they're neutral. So they are in a war setting, they don't take sides at all and that allows them hopefully to gain greater acceptance than, than some other organizations that may or may not have a, have a feeling about the rights and wrongs of a difficult situation of conflict situation. And they try to tie that with the fourth one, which is kind of bearing witness. So it's kind of saying what's happening in sort of a uh less than sort of for your ulcerative way, I guess. Um and sort of like laying, you know, opening up, opening eyes across the world on certain problems, a certain difficulties. Uh but within the boundaries of maintaining acceptance and maintaining neutrality anyway, that's, that's, that's kind of what they're built on and they're very, very, very strongly adhere to those two that framework. And I think that's, that's a, that's a positive thing overall, very quickly. Over all the 66,000 people who work for MSF and 55,000 of those are national staffing countries and they have a budget of 1.3 billion lbs a year so massive and that's made up of six million individual donors. So again, it's, it's individual donors who fund MSF, which makes them independent and says, right, well, we can go, you know, we've got our own supply chain, we've got our own medicine sources. We've got every, you know, we can just go to this emergency or if we want to or to this developmental setting, if we want to and they don't have to ask other people for it. 82% of the incomes mental field missions and to date helping about 10 million people in some of the hardest to reach areas in the world. Obviously, lot of people think about the medical projects in Humanitarian Reef. But MSF got a huge logistical and supply chain and lots of opportunities to get involved with that if you're non medical and it's got a big increasing epidemiology and research center. So with that kind of budget, you'd expect quite a lot of research and you know, availability of of of research projects across the world. And that's an increasing thing in MSF, which is quite an exciting thing I think to potentially get into. They also do quite a few campaigns like things like medicines shouldn't be a luxury and trying to reduce the price of medications across the world and the stuff that stuff that anyone can get into at any time. Also doing some big projects about the migrant health in the in the UK at the moment and thinking about the Rwanda Bill and that kind of stuff. So lots of things to get involved with at different times. So I was going to talk about some of the missions just to give you a flavor of what pediatrics might be like in, in, in some of the places with MSF, if that's okay. And I hope it's vaguely interesting and I'm sorry, it's not. So, so, basically I just want to talk to you about. My first, I've been to, I've been to Myanmar with them with the RCP CH was, which was a really um sort of developmental kind of um partnership with the, with the team in, in, in a hospital and divisional hospital in Myanmar. Lots of quality improvement work, not a lot of hands on hands on treating patients', but a lot of kind of trying to work out how to improve the systems and stuff in partnership with the team there. And I really, really enjoyed that, but I thought I wanted to experience being a bit more hands on um and potentially a slightly more more emergency settings. So this is the, this is the landscape of like sort of Northwest Iraq and, and this, that's the Syrian border up to the top left. This is where MSF were when I was in Iraq and I was in Zumar, you can see up there at the top of Mosul. And the way that MSF do is Erbil is the, is in Kurdistan. It's relatively safe area wasn't taken over by ISIS and that's where the coordination is for the Geneva branch of MSF. And then they're in these three areas for different reasons. So there in Mosul, basically, because this is a pediatric ward in Mosul. So as everyone knows, Mosul was subjected to horrific violence, war and conflict and um subjugation by I S and the infrastructure just completely disappeared. And that's Mosul General Hospital. Uh and that's the west side of Mosul and I was there in 2000 and 18. So about a year 18 months after it had been liberated from I S, but it's still very much looked like this and it was still very much in ruins. Um So they're Mosul for the lack of infrastructure and pretty much within weeks or within a week, I think devices being driven out. MSF had set up a clinic there which then turned into a larger hospital. Zumar up the top was strategic because they're at the front line with ISIS ran basically just underneath them are so it's very close to the front line, but it cut off Zuma and everyone beyond that from, from reaching emergency services. So a sort of strategic view to put a hospital there to to to increase, to increase accessibility and then see new knee over there to the left. I don't know, many of you will have will have heard about the Yazidi population who were horrifically affected by ISIS and many of the men were killed and many of the females were sold into sexual slavery, unfortunately, and they're very marginalized population who don't trust either the Arab population or the Kurdish population in that part of the world um for complex political reasons. And, but they're very much clustered in this area of cinnamony, extremely traumatized and marginalized and group. And so um S S a hospital there that's obviously open to everyone, but it's more for, to, to, to, to increase access to that specific population. Um So just interesting to think about the different reasons, even in a small area, why you might have three different hospitals and completely different for completely different reasons. And it's just interesting to think about the rationale for being there. And so this is the, this is Sumas, that's where I started and that's the red line was the frontline with MSF. And you can see that Zuma was cut off with the front line for Isis and you can see that Zuma was cut off from the hospital's below it, Mosul and Telafar. That's why uh Zuma took a changed hands a few times during the, during the occupation. And so this is what a lot of the village looks like. Now, this is the MSF Hospital and with a few kind of security features kind of built in um for, for staff, a few bullet holes in the roof, but otherwise sort of a relatively modern hospital. Uh and this was the compound, I'll just give you an idea of this is kind of working and sort of, I guess a middle income country, you'd say obviously Iraq, which was, which had a functioning health care system before the, before the water, the last decade or so. And this is the MSF facility here. So, you know, something that you recognize as a, as a clinic in a proper, you know, building that's made of concrete, uh, clean, you know, clean floors, um, hygiene taken relatively seriously can see equipment, people wearing scrubs looks looks a little bit like you'd expect in, in, in the UK. Right. And that's, that was our resource down at the bottom. And again, you know, you think of working across the world and I imagine it's the zones you do. You know, I'd recognize this, this doesn't look too different from Bristol resource um to me and take that either way. But yeah, there's a, there's an airway trolley, there's dinah map, there's um there's, you know, cannulation trolley and stuff, it looks moderately similar. So this is one kind of model of care which, which I've been involved in. And this is probably the most familiar to, to us as, you know, we'd be trying to deliver sort of Western style care, but, you know, with, with limited resources just while you're on this, I wanted to sort of use this to highlight and some of the colleagues that you meet as well when you're working with MSF. And uh you know, I don't think, I mean, I, I certainly have come from a relatively sheltered environment in the UK and got into medicine because I used to watch, er, as a, as a teenager and turns out no one remembers, er, anymore. But, you know, hospital drama from the US George community started, there was a pediatric emergency medicine doctor. I was like, oh, that looks pretty good. He seems to have quite a good time. Um, but you forget why, how people get into it across the world. I just want to tell you a quick story. Uh friend called doctor Mohammed who was, who I worked with in in in Iraq who was studying mentioned Mosul and was asked to join ISIS by, by them when they took over the city and he refused. So he was imprisoned and then he was only let out by one of his friends who was one of his classmates at school who just happened to be the person with the keys to the where he was and he was let out. So he ended up paying. So we wanted to kind of continue his medical studies. So he ended up paying half of his life savings to get to Baghdad. And he went to the to the car at four AM that was going to drive him to Baghdad. And the guy said to him, I'm sorry, you know, someone else has paid me more today. I'm not taking you, you have to come back tomorrow, it's a really dangerous thing to go across Mosul at four AM. It's pretty, pretty suspicious when, when ISIS are sort of controlling the place with martial law. And, and so they got into a bit of a fight but then ended up, they didn't take him and, yeah, so he had to go home and he found out later that day that the, that the car had been hit by an American drone strike and there were no survivors. Um So he then decided he'd stick around, it was too dangerous to leave. So he stuck around. And sometime later, he was going past the school that didn't teach isis ideologies. E and he saw a nicest member plant a bomb outside the school. And so he said to his friend who was there, like one of us goes to police, one of us going to the school and his friend healthy said, yeah, I'll go to the police, which was probably the safer thing today. And so Mohamed went into the school helped sort of divert the students out a different way and then the police came and defuse the bomb. The problem was later that night. Um the I ISIS took over the local mosque and they, and they called everyone to the, to the football field and they dug a grave in the football field and they brought out his friend for going to the police and snitching on them and they burnt him alive in front of the whole of the community um For that. So Mohamed decided he had to get out again. So he paid the other half, his life savings managed to get a lift to Raqqa in Syria. Uh And then from there to the Turkish border, walked across the Turkish border across the mountains, got a flight back to Kirk Cook in Iraq, finished his medical studies there. And then the week that the ISIS were driven out of Mosul came back and I just wanted to give back to his community. So joined MSF in a way to sort of work with an international organization just to try to support the local community in, in Mosul. And he finished that story by saying, how did you get into MSF was like, no, let's we'll talk about you a little bit more. Um And he was an incredibly inspiring and humble person. Um And you realize the back stories of a lot of the people you meet is, is very obviously inspiring and very humbling. Um And this is, this is Doctor Mohammed just here. Um And just, just, just an interesting kind of reflection on some of the people you meet. Um So from, from, from Zuma, where you were giving sort of moderately Western style care, and I went over to, I went to Mosul and Mosul was a kind of a 40 bed pediatric hospital with about 15 neonatal beds, something like that. And, and had x rays had, didn't really have sort of, had had oxygen cylinders, had had enough pulse oximeter is maybe twen maybe 10 pulse oximeter is 15 pulse oximeter, something like that. And so I had enough enough capacity to give some recognizable care that we would assume, you know, we would think is appropriate in the UK. Next mission was in Sudan and then this was the entire mission basically in this place in Sudan, it was part of a maternity hospital and we were given this one room to say, right, can you set up in the natal unit in this maternity hospital? And we started off with one bed. So going from a very functional, very built up hospital with a lot of capability, we went to a one bed neonatal unit. We ended up just sort of stealing slash borrowing various trolleys and tables and beds and other stuff just to try to make this this neonatal units sort of get it off the ground. And it was in quite auroral location, there were frequently more goats in the hospital than doctors, which is obviously isn't uncommon. Um and required quite a lot of improvisation. So this is, I don't know if anyone's come across this before, but this is, this is how you can make CPAP if you, if you need to. So this is a baby with severe respiratory distress and basically, we don't have CPAP machines, but CPAP is breathing out against pressure. So if you take normal nasal cannula and you form a seal in the nostrils and then you cut one side and you tape it to a pen, then you put the pen underwater. And so then when the baby breathes out, they breathe out underwater. And if you put it four centimeters underwater, then it's four centimeters of CPAP, it's six centimeters, etcetera. So you can kind of do the pressure's a little bit. So this was kind of very much as you can see quite different location to, to, to Iraq, quite different expectations, quite different capabilities. So interesting to be doing sort of different things and, and, and definitely having to think on your feet a lot and, and be a bit more improvisational. That's a word. Um Just put this in there because this was Iraq was quite, not dropped, but it was security conscious. You had to be finished by sort of 4 30 every day. You work eight till 4 30 but then you'd very much be between a guest house and the hospital and you go in convoy and that was it, you know, so you can go anywhere else at all. And security was very, very tight where Sudan was kind of felt a lot more culturally open and it was a very vibrant place, a really colorful and place in a really enjoyable place to be sort of in your spare time. A little bit more, which was, which, which is obviously helps a lot with the we're getting through a mission. Um And also the team in the team in, in Sudan was a lot more mixed in that. It was more sort of national staff and, and a more continental based staff. So either from, from Sub Saharan Africa in general or from Sudan itself. So it kind of felt a little bit more culturally appropriate um than a lot of the team in Iraq being from, from around the world and being sort of mainly whiter expats. And so moving on from now, I'm just kind of giving a flavor of different kind of context if that's okay, just kind of give you an idea of kind of what, what some of it's like from a pediatric perspective. So this is, this is ***. *** is 187 out of 187 on the U N Developmental Index. So literally the least developed country in the world for various reasons. And this is down in the south, near the Nigerian border. So kind of Boko Haram kind of territory. And this is the front door of this pediatric hospital and it's very unassuming. This isn't, it doesn't look like there's a particular big hospital behind it, there's an 800 bed pediatric hospital behind him which sees about 20,000 Children a year, nearly all of them grossly malnourished and it is just a factory. It is just a, it's an uh in credible distressing, sort of slightly traumatic but amazing place. Just give you a little flavor of the kind of this, which is very different to the one bed neonatal unit, which was just before it. Um, but it gives you a flavor of the kind of the general, the variety that you see, which is true of pediatrics in general. Right. So even in the UK, if you go in, at eight o'clock in the morning to a pediatric ward, you maybe intubating a 24 week er baby putting a central line in etcetera, you might be in resource with a 15 year old with procedures might be in clinic with CF patient or an asthmatic patient, he might be on the ward round seeing cardio rest, gastro psych neuro everything. It's very much the same in a global health context. You might be seeing anything at any time in different kind of locations. So this um this is just a graph and want to kind of, well, things to look at on these graphs are these are attendances and deaths in this in this unit. Um And particularly want to look at the bottom is the, is the one on the right at the bottom, which is the number of deaths in per week in this in this unit. So you can see there's a massive spike in August and September and that's basically where they're, it coincides with the rainy season where the crops have normally failed or run out. So it's not time for harvest yet. And then there's a rainy season which brings a lot of water, standing water and malaria goes absolutely crazy. So you get famine and malaria. At the same time, you can see there, we've got about 98 pediatric deaths a week in this um at the, at the peak of that, of that red graph. So pretty, pretty intense, lots of things, lots of things happening. And I guess how do you deal with that? And so this is the intensive care for um for malnourished patient's. So these are genuinely probably the sickest patient's of any pediatric patient in the world. I challenge anyone to have sicker patients than these ones at the top end of this because they are grossly malnourished and they, their, their, their physiology just doesn't behave like like any like other children's physiology. It's, they just don't have those coping mechanisms anymore. And so they require really careful care, but very, very simple care. And I think that's the message from this, that, you know, this is just one room of about 20 different rooms full of full of Children at different stages of the malnourishment journey. And and here's where we're trying to stabilize them. And I was not particularly useful because I, I had never seen really a lot of malnutrition before. So this is really learning a steep learning curve for me. But these guys, the guys in white of the nurses and the guy and then yellow is the nutritional assistant and they were absolutely phenomenal and, you know, they've lived and breathed it for years. And so what you normally do is you'd see a patient on the ward round and you'd write instructions for the day on these little pieces of paper and then you just stick it to the, to the, to the bed and then they basically just be going around in a circle and just like every time looking up what's on the instruction. Okay. Let's do that. Let's put these fluids up. Let's do this, let's take this down, let's give this antibiotic and stuff, take the paper down, screw it and throw it away and then like, wait for the next one to come up and just around in a circle and the guy in yellow would be doing exactly the same thing which is with the bucket of milk in his hand. And so for malnourished patient's, you start with very low calorie milk and then you kind of build up as they were able to tolerate more and they're really kind of regrow and, and he'd be going around with a bucket of milk and just looking at the value of the volume that everyone was meant to have every three hours and just doling it out to the mom and then they put it down and then g we'll try to feed it to the child and just keep going around in a circle and it just seemed to work. And every time a patient sort of improved a little bit, they can move onto the next phase. So this was like the intensive care phase. So then you go into phase one where you got a different, slightly different milk or slightly or whatever and then to transition phase and then to phase two where you get the plumpy'nut, the the really nice tasting peanut butter salty thing and you say, right? OK. I think someone can go to phase one and literally you would look around and that guy in yellow would be there and he just fold up the child with the bed with all of the sheets of the bed and be like mom go on and just run them to a different to a different unit, you know, waiting for a bed to be ready and no calling the nurse in charge of this kind of stuff, literally just folded up whole thing, run to another unit popped down and they were right now you're in phase one and the mum would be coming behind with all the bags and stuff, but really interesting way of working and definitely gained a for me selfishly gained a lot of skills. They're about prioritize about prioritizing, about recognizing sick Children, about giving really simple treatment. The only treatment here are milk fluids, oxygen and antibiotics pretty much. And with that, you're, you're, you're getting a lot of Children better who would definitely diet otherwise. So, really kind of made a big impression on me that although a lot of Children are dying, a lot of them are also surviving. So there's 20,000, a year, 18,000 survive. And none of those would like, pretty much none of those would without this very simple facility being there and having this kind of factory kind of output. And obviously, we don't discriminate MSF, we treat everyone all mammals of all of all sorts. I'm just gonna touch very, very briefly on South Sudan and then just talk a little bit about getting into MSF and that kind of stuff. So this is the most recent mission that came back from. So just at the end of last year, this was in a place called A B A which is just between Sudan and South Sudan too, right on the border in an administrative region that's not claimed by either of them since the civil war. So kind of there is no infrastructure there really, it's a very beautiful place. Um This is the sort of normal village, every village in town looks very much like this in the area. So no electricity, no running water, etcetera, etcetera. Um And then this is the hospital. So a kind of hybrid situation where it's not quite the Iraq thing, but there was, there was surgery, there was a maternity, there was neonatal care and stuff and there was a moderately permanent buildings there, but equally, there was about sort of a 200 bed pediatric unit, something like that. So, somewhere between Iraq and, um, and *** for me, and there's a very small tour of possible in, in, in animals. So cats you might expect. This is the H D you, so this is the sickest patient. We had a 12 bed HD you with three nurses who could keep pretty good monitoring them. Um, a goat who's, um, who's sort of joining a conversation in the A N D and a hedgehog in HD. You who knew they had hedgehogs in South Sudan? Um And I don't know, you can see that there's a family of kittens just living in a potty in the pediatric ward there. Um, but just can give you a favor of what that looks like. He was the best team that I've, I've worked with and they were unbelievably proactive, um and knowledgeable and willing to share knowledge and wanting to work really together as a sort of a diverse team together. Um And this was very stark contrast in *** where a lot of the team were very traumatized and that's quite a challenge to get over. Whereas here it was a very welcoming environment to the very, very impressive and friendly, a friendly team to work with. I just want to tell a couple of patient stories because that's obviously what we're there for and just to give you an idea of some of the medicines. So this is, this is a little bit, this is kind of one that just sticks in the memory because it's a little bit extreme. But this is a baby who came in after having so five days old, born at home, came in blue saturations of, I think 18% when they came in, they've been having seizures for about 24 hours off and on. But mom had walked, taking a 24 hours to walk to the hospital and the heart rate was about 20 when they came in some of that. So it ended up needing quite a lot of resuscitation. They see the bag valve mask there in the background and, but we got some fluids, got some antibiotics in and sort of gave some oxygen bag them up and then, and then put them oxygen and I left for the evening. I said, right, you're, you know, do your best. But I think this child, unfortunately going to make it and I got called back in about 10 o'clock saying that they were desaturating to 60. They're working really, really hard. So I ended up setting them up on the CPAP that we talked about before. The kind of improvised path. Like then the next morning I said, you know, how helping you, how long did they survive? And they presume he died? Like, no, no, no. Come on. Come on. Look, they saturating like 98% on the, on the CPAP. So we're like, right, there's an opportunity here to transfer them to a government hospital. That's about 2.5 hours away who do have a neonatal unit. So why don't we, should we try that maybe. And so we call this ambulance and this time it's turned up and it was, it was a toy to pick up truck with no, with no sides just completely open to the elements. And they said, can you fill us up with petrol? It turns out that Sudanese Arabic words for petrol and diesel are the same. So MSF cheerfully filled up with diesel instead. Um but once we sorted that out, we managed to sell it eight this baby into the back of his ambulance with our only sounds probe and on this kind of made up CPAP on, on a pole that was elevated to the side of it and they went off and they went to the MSF office and they said, look before we go, you got to pay us $50 for our fee for the day, which is reasonable, but unfortunately, turned off the engine which was running the oxygen to the baby through the oxygen concentrator. So baby d saturated, decompensated heart rate, sort of below 60 again, needed resuscitation, ended up running back to the hospital, getting them back on the CPAP and again, somehow sort of picking up there. And that's so next day I said you're going to go nowhere like we don't want to go anywhere with you. We're going to put you just, we got an incubator, which with the Japanese government has donated some time before. And we uh we said, right, you're staying here. We did about five minutes of me saying that the the electricity cut off and we only had one concentrator that worked on battery. So we had this baby in another baby who needed it and we had one pulse oximeter. So we basically put the pulse oximeter on one baby and then the auction on the other baby. And when the sounds got to 70% then we switch them over and kept switching backwards and forwards for about an hour, two hours. And unfortunately, we came for the generator. Um, so and maybe they're desaturate throughout this time as well. So big hypoxic, you know, insults basically, but two weeks later, this baby was ready, was ready for home with breast feeding, well, gaining weight as someone with the bags packed and um I'm chilling out with some of the other babies on the units at the time who were at the same time, sort of needing oxygen. And that, that was the baby on the right is the one that we're having to switch it over with and then came back to another two weeks later and then pretty optimistic Lee size dress. Um, but apparently still doing well and you know, maybe a little bit of neurodevelopmental compromise, potentially, but still pretty much neurologically normal. And again, it just made me think with very simple care. Again, fluids, antibiotics, oxygen, you can, you can, you can, you can have really positive outcomes and you can help other teams have very positive outcomes which maybe they didn't believe was true in babies before because they're just not experiencing it. So that was kind of really inspirational one for me Very, very quickly. This is another child in, in them in *** who was now nourished, who ended up going to the to the resuscitation beds. Um And here it says give the flu bolus moved into the resuscitation bed and that normally spelled unfortunately pre terminal stuff. And I was reading this two days later and looking up at the child and this was the child in front of me. And again, I was like, oh my God, like someone, someone's got the wrong notes here. Like can you find the right notes? So like, no, no, no, this is the child. This is the right one. And and yeah, again, quick turnaround with simple care. Uh and I won't go through this one, but this is a very semester. This is someone who's been fitting for 48 hours with meningitis and cerebral malaria in South Sudan who spelt spent I think 13 days with G CSF three just with simple stuff by MG, feeding fire, mg antibiotics, antimalarials. And uh eventually this is on, this is three or four weeks later, um able to, able to give us a little bit of a wave um uh with a fantastically inspirational and supportive family and her dad and mom in the background and then went home and came back to us again, sort of neurologically a little bit with some difficulties but making fantastic progress about a month later. So again, it does, you got to hold on to the ones that do make sense to you. You can skip through a little bit of this just to get to the finish. So just a couple of other things I wanted to talk about, we're having an opportunity to, to experience different cultures, I think is a really positive thing in this. So I was very lucky. I kind of joined a local football team in them in um in Sudan. They thought I was kind of a secret weapon because I was like a British footballer. I definitely wasn't more of liability. Um And then joined a band in, in ***, which was really fun, got invited into people's homes just to really kind of share in, in their, in their lives a little bit, which I thought was really special and just thinking about working for MSF just in the last two minutes and that's OK, sorry. Um is so just thinking about the basics of working for MSF. So third problems magically, you know, you've got five minutes left and also some time for questions in that five minutes. Yeah, perfect. I'll be, I'll be one minute and 30 seconds. Thank you. So basically just thinking about working in a global health context, the thing I'd say is decide what makes sense to you in that global health context. So it may be very different things. It may be kind of the capacity building and the and the sort of, you know, quality improvement projects that the in Myanmar, maybe the really kind of patient care focus stuff in and in MSF for, for me, it may be teaching, it may be educational stuff, it may be research or it may be kind of policy or it may be kind of campaigns and advocacy, advocacy and that kind of stuff. So there's so much out there and you know, I've been very lucky to do one sort of one or two bits of that, but there's such a huge world out there and you can get into any of it through pediatrics. For MSF, you need at least two years in specialty. So that's um if that's P as you need to be an S D three to do, mm S F, they strongly recommend doing the diploma, tropical medicine and hygiene. You can do that in a few places. Noted the Uganda London Liverpool. I did mine in Glasgow because it was a distance learning course. And then I still got paid at the same time, it was about heart about a third, the price of the other ones. And it meant that I was then ready to go out with MSF afterwards rather than going out and then sort of having to take more time off. Second language is helpful. English is the language of MSF. But speaking French or Arabic is really good. Also Spanish, Russian, Hindi. Uh and you have to have a minimum three months' experience traveling or working abroad at all. I'll just say that there are huge benefits to working abroad for yourself. Like it's not, we don't go out there for ourselves clearly. But you get a huge amount of clinical skills from being out there. You get a huge amount of personal skills as well. Just realizing your resilience, what makes you strong, like how you get through stressful situations, you find that your limitations, you get a lot of coping mechanisms and I felt a lot of times well, if I've done that, then actually I can do with this terrible shift in A and E because I remember that shift I had abroad and it was, it was terrible. Um You also get a lot of quality improvement work that you can do and you get to implement it very quickly and get turn around very quickly. You're not asking management and ethics and all this kind of approval, which is good and bad. But you get a lot of experience doing that, managing teams being innovative with what you do and then all of those things go really well for any applications you ever make. And I spent most of my applications for grid and for consultants talking about work that I've done abroad, you got to do it the right time in your life, you've got to fit into your career. Uh And for me that was taking some movies and I took some movies and I really pushed on the skills that would give me that I bring back to the NHS and that was the key way to get them and, and some of that was spent learning French some in Myanmar and then did the D T M N H and then eventually got to myself as a whistle stop tour. Hopefully it's giving you a little bit of flavor and, and please hit me with any questions now and you're very welcome to email me any time and my email is just, they're always happy to chat if I can be helpful. Thank you. So we've, we've got a few questions when we have to get to all of them. Do you mind after we answer one or two just staying in the chat to answer anyone for next couple of minutes? Okay. Yeah. So I think a really good, a really important one uh from last is how do you suggest getting the experience to work three months abroad before you start in MSF? Then there'll be a barrier for a lot of people. Yeah. So it's um it's both, it's both working abroad and, and traveling abroad. So even if you've kind of traveled abroad for um for three months at some point, just living and immersing yourself in a different culture and sort of becoming resilient in that culture is, is accepted. So it doesn't necessarily have to be medical work. Um So that, that's kind of a nice way around it. Otherwise MSF is quite often probably going to be your second stop on your global health journey because you have to be kind of have to be a little bit more senior because you're running a team a lot. The time you're supervising a team to have that by in and have that authenticity. Sometimes it's better actually to do a to do work with, with, with another NGO first potentially, which is more like maybe hands on or maybe more quality improvement or whatever and then maybe work where you're being more of a supervisor in MSF. I first did MSF post ST five and I was quite glad I waited till then, but you could do it from ST three words, you have any replaced or any other NGOS you could work with at an earlier stage to get that experience and you could do MSF for the second. So I, so I did RCP CH I would highly recommend global links. I thought they were really good, really supportive. Um And they're variable kind of experiences there with them, but that's the same in global health anywhere emergency have heard really good things about from some of the friends who've worked with emergency. It's an Italian NGO. Um Obviously VSO, I haven't had a lot of experience with, but a lot of people have and I think they have longer missions but uh you know, a really good organization to go with as well from the sounds of it. Okay. Perfect. Thank you so much. That was a really good talk. There's a few more questions in the chat. So if you could uh just answer them, that would be great. It was really interesting talk you're hooked on and thank you so much for coming. So now I'll hand over to Stephanie to introduce our next speaker. Okay. Thank you so much. Thank you, Doctor Mali again. Um I have the wonderful opportunity to introduce our next speakers which