43. What's It Really Like Working for Doctors Without Borders? | Dr Justine Cain

Most doctors spend their careers working within one healthcare system. Dr Justine Cain chose to take her skills across borders. Through her work with Doctors Without Borders (Médecins Sans Frontières/MSF), she has cared for refugee communities in Lebanon, supported emergency responses in India, and discovered lessons about medicine that can't be learned from a textbook.

Justine takes us behind the scenes of life with Doctors Without Borders, sharing the realities of humanitarian healthcare and the unexpected lessons that come from working across cultures, communities, and healthcare systems. Along the way, she reflects on the value of adaptability, teamwork, and embracing opportunities that sit outside the traditional career path.

This episode is for anyone curious about humanitarian healthcare, global health careers, or the many ways a medical degree can be used to make a difference. If you've ever wondered what life is really like with Doctors Without Borders, or you're inspired by healthcare professionals who choose the road less travelled, this conversation is not to be missed.

Justine's organisation of choice is Médecins Sans Frontières/MSF, an independent international medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, healthcare exclusion and natural or man-made disasters.

It Takes Heart is hosted by cmr’s Samantha Miklos and Kate Coomber and recorded at cmr’s head office in Brisbane.

We Care; Music by Waveney Yasso

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Transcript

A Winding Route Into Medicine

Sam Miklos 0:00

What if the most impactful medical careers aren't the most traditional ones?

Dr Justine Cain 0:04

And I think I remember being on my first assignment in Lebanon, and I remember thinking this is why I did medicine. This is this is what I want to be doing.

Kate Coomber 0:13

Don't forget to subscribe wherever you get your podcasts and follow us on YouTube and Spotify to see the interview in full.

Sam Miklos 0:23

So today's guest has designed a medical career full of purpose, courage, and freedom. Dr. Justine Kane joins us today to talk about her diverse medical career, which has led her to some of her most important work yet. Welcome to It Takes Heart.

Dr Justine Cain 0:38

Thank you very much.

Sam Miklos 0:40

So, Justine, can I ask before we even get into your career, like what inspired you to take on a career in healthcare? Was there something for when you were little? Was it what you always wanted to be?

Dr Justine Cain 0:52

Um I think yes and no. I think I really enjoyed the sciences at school and then in high school enjoyed legal studies, and so I ended up doing science and law as my undergrad and worked in the government for a couple of years on Torres Strait Fisheries, which was a little bit different. And then from there I thought, no, I think I want to try and get into medicine, and so sat the Gamsat and went through that process and yeah, got into medicine and absolutely loved it. I just loved the content, I loved the people, I loved everything about it. I love that real human-to-human nature of medicine, I think. And um so yeah, I think in the back of my mind, yes, I always wanted to do it. Um but it was a bit of a windy path to get there. And I think, you know, I look back now and you know that I've had some best some of the best experiences by having that path and taking that journey that wasn't, I suppose, a traditional journey to medicine. Um so yeah, and I think from there it's always it's been this path of figuring out what to do within medicine as well. So it's the decision to do med, but then within medicine there's so many different opportunities and different paths that you can follow and um and change that path as well along the way, which is kind of what I think I've done a little bit of as well.

Kate Coomber 2:17

Talk us through a little bit of that career because you're right, there's so many choices in medicine.

Sam Miklos 2:21

It's not just I'm gonna be a doctor, linear path to where you're gonna do it.

Dr Justine Cain 2:28

Um so yeah, I I did my internship up in Townsville, so and that was yeah, really interesting experience. I was able to go up to Palm Island and do some work up there.

Sam Miklos 2:40

Um did you choose that internship location after you'd been up in the Cape or was it?

Dr Justine Cain 2:46

No, so how it worked at the time was that um it was a random ballot, so for particular hospitals. So some hospitals get under subscribed, some are oversubscribed, so there's a random ballot. Um and I was planning to go to the Gold Coast, that's where I trained, uh, and I got randomly ballotted out to go to Townsville. Um which was actually How did it feel in the in the moment? I think in the moment it was I didn't expect that. Um but you know, you you got to roll with it and go with it, and I think it was an amazing opportunity to go further north to see more tropical disease and certainly some um diseases that I hadn't seen before or come across, some opportunities to work in First Nations healthcare as well. Um so I was up there for a year and then I came back to the Gold Coast and completed two years of residency on the Gold Coast, and it was during that time a lot of people were very aware of what specialty they wanted to do, and there was a lot of pressure, I think, to choose a medical specialty. Um so people sort of, you know, doing their masters or they were doing research and they were really working towards a specialty, and I had no idea what specialty I wanted to do. I liked a little bit of everything. So um, so I did um what responsible adults do, and I took a year off and I went backpacking.

Sabbatical Then Choosing General Practice

Speaker 3 4:12

Just got away for a bit.

Dr Justine Cain 4:14

That's pretty much what I did. Um, so yeah, I was a bit too old to call it a gap year, so I called it a sabbatical and did a little bit of volunteer work in Mexico, but I just predominantly backpacked around. Um, and then I came back and and started general practice training. I thought that that was the a really nice balance of a bit of everything in medicine because you do really see you know the the weird, the wonderful, um, and you see little little bits of everything. So I thought that would be a good fit for me. Um so I did the um GP training, which was a couple of years, um, and then I sort of gravitated more towards First Nations healthcare again because I was really missing working as part of a team, and I think that's something that I didn't quite consider when you're looking at a specialty. It's sort of looking at the content and and what you will be doing day to day. But I think for me I really love working as part of a bigger team and um and I was missing the emergency department because I'd done quite a bit of work in emergency departments.

Kate Coomber 5:15

So it's interesting, isn't it, when you you probably don't consider as a GP, you're sitting in a room on your own. Obviously you're seeing the patients and that's the interaction, but as part of um yeah, collaboration of a team, it must be quite solo.

Dr Justine Cain 5:29

That's what it felt like uh at times. Um so very busy during the day seeing you know many patients. Um but often if you know you when you finally did get something to to eat or grab a drink of water and you didn't cross paths with your colleagues, it felt like you didn't even see your colleagues all day. Um so I actually worked in a um Aboriginal medical service and that felt much more like part of a team. Um I was able to work with the you know nurses, the health workers, Allied Health, so I really enjoyed that. Was that here in Brisbane? Yeah, yeah. Yeah, up in Northgate. So um I really enjoyed that. Um but as

Finding Doctors Without Borders

Dr Justine Cain 6:06

I said I was sort of missing the emergency department, so went back into um doing some emergency medicine um before then applying for MSF. Um so or Medicine Some Frontiers.

Sam Miklos 6:19

So you said yeah, I was gonna say what does MSF stand for?

Dr Justine Cain 6:24

Um so yeah, Medicine sans frontiers or um I don't I don't even know my French is that you just said that. Really quickly and frontiers, was that or Doctors Without Borders? Doctors Without Borders, yeah. Let's just roll with that. So and um so that's uh um an international humanitarian medical organisation, so um it was founded over 50 years ago. How did you hear about it? So I heard about it as a medical student.

Sam Miklos 6:56

So I think That's a long time then from you know, like if you think about that little moment.

Dr Justine Cain 7:01

Yeah, absolutely. I think it it sort of planted that seed um in the back of my mind hearing you know, another doctor talk about their experiences, and I remember they were based um in Chad in in Africa and and just hearing the work that they were doing and contributing to, and I thought, okay, this is something I want to keep in the back of my mind for when I feel that I'm ready. And so I think that was the you know, as I was weaving my way around in various areas in general practice and emergency medicine and different areas in Queensland, up in Northern Territory, um, doing some locum work around the place as well. I think that it was at the in 2019 that I felt that I had a good skill set that I could actually provide some some value to the organisation, and that's when I first applied.

Sam Miklos 7:53

So, what can I just ask then? You said um when you were ready, what are the and it's probably now even more so having done the work, what is the skill sets that are so valuable and you know that someone really needs to get, or is there skill sets too that you thought you needed that actually you you didn't, and there was others that you'd underestimated?

Dr Justine Cain 8:14

So I think um I was sort of considering it as technically ready, I suppose, but again, it's that um it's not just the technical skill. Uh I think the things that were useful for me was that I'd traveled a lot, um, that I'd been away from home, that I'd been away from creature comforts of home. Um I think that it was really important to work in low resource settings, um, particularly in rural and regional areas. Uh I think that it was useful to have started to do some um studies around tropical medicine and public health. Uh, that that was very useful. So I think um they were probably why I felt that I was ready. Um but again, I looking back, I don't know if you're ever really ready. Um but it's interesting that probably yeah, it's not just technically ready, but you have to be ready in other aspects of your life.

Kate Coomber 9:12

I imagine personally ready. You have to, you know, like how long do you have to go for? Can you talk to us about where you've been, how long do you have to go for? Because even that from a personal level is when does that factor into life?

Dr Justine Cain 9:24

Yeah. So I think, yeah, being technically ready, but you're absolutely right. I think being personally ready, financially ready as well. Um so all of those factors, um, because for the first assignment that I went on was for nine months, so they do ask for a minimum of nine to twelve months for your first assignment. Uh that depends a little bit on what you're doing when you go there. Um, so for um if you're a surgeon, for example, it might be three months. Um, but for me as a medical doctor, then it was a requirement for nine to twelve months as the first assignment. So it's a long time. It's a long commitment.

Sam Miklos 10:03

Why and why do you think they have that longer commitment up front?

Dr Justine Cain 10:07

I think it's really to get a good sense for the work that you're doing and to realise that you know just because of how I do something here in Australia might not be the way that it's done in another context, and so it really takes that time to learn the context, to learn about the organisation, to really work as part of that team to you know to to improve things or change things or um support uh in different ways. Um, and I think that's the important thing that you don't go in there on a day one change how everything's done because it might be in do done that way because of a number of reasons that you don't know about. So I think for the first time that you're there, having that time to really settle in and and figure out the ropes, I suppose, of how everything works.

Sam Miklos 10:57

And after that initial stint, what's the minimum expectation then for your further locums?

Dr Justine Cain 11:04

So if you go as an emergency project, it's usually less, uh, so it can be a couple of months. Um but you can also go for several years in particular um positions as well. So there is a lot of flexibility. And these are paid positions, not volunteer positions. Yeah, so it is a paid position, um paid quite a bit less than what you would be paid here in Australia. Um but I guess for me it wasn't going for the money away, you know, it was I'm incredibly privileged that I can work here, save my money, and then go away with MSF and and get paid. Um but you know, you get paid a a living allowance and you're not paying for all those things that you pay for here. Yeah. Yeah.

Kate Coomber 11:50

And so when you talked about having the skills that were required to be ready, what you didn't really touch on there was the emergency skills necessarily more about the tropical medicine and the public health. I guess people might take uh sort of assume that when you go it's all you know high trauma. That's the big set, but uh is that not the case? Like where where have you been and what was the work that you did and what was the environment like?

Lebanon Refugee Clinics

Dr Justine Cain 12:16

Yeah. Um I think it's a really important question because I think there's a lot of assumptions about, you know, um what people see um MSF doing and and assume it's all you know wartime conflicts or news and things and hospitals and trauma related. I think that's what I found really interesting with MSF that it it does work on that front line of of emergency medicine, but it also works on a whole range of other things. So for my first assignment was to Lebanon, and I was working in primary health care. So we had four standalone primary health care clinics, and they were amazing. So patients would come in, it was all free of charge. It was predominantly Palestinian and Syrian refugees, but also vulnerable Lebanese, and they would come to the clinic, they would be triaged by our nurses, and then if they had one of the conditions that we could treat, and because we were primary healthcare, we were predominantly focused on NCD or non-communicable diseases, and that was diabetes, so type 1 and 2, ingestational diabetes, hypertension, asthma, COPD, epilepsy, kidney disease. So we had sort of our list of conditions we could treat, and then they would come into the clinic, they would have a set of vital signs done. We had point of care testing, so little blood test where we could see what their sugars were doing, what their electrolytes were, what their kidney function was, and then they would see a doctor, the doctor would examine them, and then if they needed medication, prescribe medication, and we had an on-site pharmacy that would dispense all of the medication, and then we also had social workers that could help with the social aspects. Um, we had mental health team psychologists that were available, and we had um yeah, we had education sessions in terms of lifestyle changes and modification, which we know is really important for managing chronic disease. So it was this whole sort of package of care that people could have when they came into the clinic, and then they would leave with their medication and then we would see them in three or six months' time. So it wasn't your you know, hospital trauma and emergency. But what's really interesting is that in chronic disease like diabetes, for example, or type 1 diabetes, people are reliant on insulin. And if they have to, you know, to flee an area, if they have to move if they're living in a tent, um, you know, if they don't have their insulin, then that's life-threatening. So even though it's not what you think of when when you when you think of trauma, um, it's still absolutely a medical emergency for these people. Um, and so same with chronic disease, that we we're trying really hard to uh I guess mitigate those risk factors that are going to lead to needing dialysis or an amputation or something of that nature. So it's more of a longer game, I think. Um but it's still just as important. And so that was actually my first assignment within Lebanon, and that's I was there for about 10 months in total.

Kate Coomber 15:28

And what was it like when you were there? You know, what what how do you live over there? What was the the rest of you know lifelike side of work?

Sam Miklos 15:37

Yeah, do you all live together or yeah?

Dr Justine Cain 15:39

So and this particular assignment, so it was based um in the Becca Valley. Um and I guess I wanted to say now is how horrible um it is things going on in Lebanon at the moment, and and thinking so much of my friends and colleagues over there. Um we we were based in the Becca Valley, which is in the Syrian border, um, and so yeah, we had uh a flat and it was a share flat, so we lived with your colleagues, so um living and working with your colleagues. Um you have your own bedroom, you may share a bathroom. Um we would usually eat dinner together, um, and then because we had the four clinics, um we might not all be at the same clinic on a particular day. Um, so we have um MSF Driver that drives you to various um clinics, and I think one of the most amazing things is that you meet people from all around the world. Um so you're actually your colleagues are from Kenya, Nigeria, from Canada, from Japan. Yeah, you know, you have such a variety of people that you meet, and I think that's really amazing because you get to work with so many incredible people based in Lebanon and hear their stories and and the experiences that they've had, and you're contributing to that, and then you also get to to live and work with people that you might never, you know, cross paths with. And so that's really interesting as well, and I really enjoyed that aspect. I think that's when we're talking about being prepared, uh I think that's one thing that you need to be mindful of as well, that you're often living in you know, shared accommodation, um, you're living and working um with your colleagues. But I've only found it really positive and really enjoyed that aspect. I think it's added value to my experience, not not taken anything away.

Sam Miklos 17:31

There must be such a shared like sense of that camaraderie and everyone's coming there for that shared purpose. I guess that's what's interesting.

Dr Justine Cain 17:40

Yeah, like that's what I missed in at times in when I was working in general practice, and so I think that's why I sort of gravitated towards working and you you do really feel like you're part of a big team because we can't do what we're doing in the clinic if you don't have running water or toilets that flush, or um you know, you're working with your pharmacist to make sure that you have medications available. You're working with your logistics team to make sure that the facility is operational. So you are really working as part of a bigger team, and we're working in the field, and then that's supported by people at a at the country level who might be more sort of working overarching, you know, HR, finance, um, advocacy, those aspects, and then that's linked in with the operational centres which are scattered around the world, predominantly in Europe. Um so it's this massive team that's all working together to really help people on the ground and and provide support. And that was really exciting to be part, just a very small part of that larger team.

Kate Coomber 18:46

It sounds like you felt very supported from all the organizations I guess you can do this with. It sounds like um very well organised and you felt um very secure there.

Dr Justine Cain 18:57

Where else have you been?

COVID In The Field

Dr Justine Cain 18:59

Uh so that was in 2020 that I was in Lebanon. Yeah, that that little thing COVID uh happened. Um so that was actually quite interesting too, because um, again, very unexpected. I left Australia just as we were starting to hear about um COVID, and then it hit, and then of course it hit hard, and airports were closed, and um so I wasn't able to come home even if I wanted to. Um, but I was very comfortable to stay there. That's what I really felt like I wanted to to help and support in that context. Um, but it really changed things a little bit for me because then I was starting to support with in terms of how do we manage COVID in our clinics because our patients are very vulnerable to COVID, and this was before vaccination, um before rapid testing and trying to organise how to make sure our staff are safe, our patients are safe. So it was a really interesting time working within those clinics during COVID. Um, and so that was 2020, and I came home around November of 2020 and had my hotel quarantine. Yes. Um and then the following year I went to India. Um, so that was an emergency assignment, uh, and that was during the second wave that happened and really hit hard. That's right, yeah. Hit hard. How was that different going into an emergency assignment? I think it was different that I knew it would be a lot shorter. Um, so it was really for a couple of months. Um, and you know, I expected rather than going into a really well-established project that had been there for several years, that this was a new project. Um so MSF was already based in Mumbai. They had a great project working on TB, um tuberculosis, and HIV. Um, so they had a project already established and then they provided support for COVID management. So it was at a the BKC Jumbo centre, which is this amazing 1,000-bed tent that was created that had ICU and oxygen capacity, because that was the time when we were seeing things where you know people were running out of oxygen and they you know they weren't having access to that basic level of health care. Um so it was this incredible thing that was done in that area with the creation of the this jumbo tent. Um, and so MSF was supporting the Ministry of Health in providing care for patients with severe COVID. So I was going there as the medical activities manager, so um supporting the team in terms of the medical activities, and it was quite a large team of doctors and nurses and anaesthetic technicians and social workers and psychologists, and our project was to work within this jumbo. Centre, but it didn't quite work out like that, which was quite interesting. How so? So it was monsoon season in India and the tent so we're working in the project and then there was flooding that happened. So then the patients sort of were all redistributed to various hospitals, and then we pivoted or changed what the project was to then really work on health promotion and community awareness and engagement. So I think that was one thing we're talking about the skills in MSF and it's expect the unexpected and that ability to really go, okay, nothing that we can do to change this, and this was not what I was expecting to do. I thought I'd have three months working in a tent. So we had loud speakers on the little tuk-tooks and we'd drive around and giving information just around, you know, minimising spread, um support for vaccination.

Kate Coomber 23:12

Because that's a really that was a wild time. Like I can't even imagine what that was like there. And just thinking about your family here, you know, we were all okay, you go to the supermarket, not you. And you're going, I'm going to work in this COVID hospital.

Sam Miklos 23:31

I'm going to coordinate all of the And the news was saying at the time like India like that second wave looked terrible.

Kate Coomber 23:37

And then throwing monsoons into it and everything being destroyed.

Sam Miklos 23:40

Like how does how do your family and friends reconcile that work? Because you see, like you know what you're going into, I imagine.

Dr Justine Cain 23:47

How did how do they feel? I I I think it's tricky for them, to be honest. I think it is a challenge. I think as I've gotten older, I've perhaps been a bit more mindful of that. I think that um, you know, in my mind, as I said to you, I wanted to do MSF work since I was a med student. So it was this long time of really working to this point to be able to do it. Um so I think my family and friends know how important it is to me and and how much it means to me. I think it's also much harder for them than it is for me because I can see what it's like on the ground. I I know how I feel about a particular situation or setting, you know, I've felt safe. Um I know it's a lot harder for them. Um I think we're lucky now with technology and I think that's a big um uh a big component, just making sure that you, you know, keep in touch and you send messages, video calls, make sure, yeah, that I'm I guess being understanding that it is it is difficult being back home and not knowing um what's going on in those areas.

Kate Coomber 24:53

So I think so the news can you know sometimes overplay, right? As well.

Dr Justine Cain 24:59

Absolutely. Uh I think sometimes the time difference help difference helps a little bit. Um I was there in 2020 when the Beirut blast explosion occurred, and even though I was in the Becca Valley, um, you know, I was able to just immediately let friends and family know I was safe, I was okay. Um I think just communication is key, uh, and I think it is really challenging for friends and family. But I think my friends and family know how much this means to me and how important it is, and so they're supportive. Um, but yes, I I think they do worry, of course.

Kate Coomber 25:31

As much as your um this is your passion, clearly, have you had moments where you have been quite scared or something has happened where you felt, you know, whether it is that explosion or something has happened where you're like, hmm, I feel a bit uncomfortable now.

Dr Justine Cain 25:47

Not not really, maybe. How wonderful.

Sam Miklos 25:50

Do you choose the locate like um do you get an assignment put to you and you can look and go yes or no? Have you gone to places where there's active conflict?

Dr Justine Cain 26:01

So um yes, you do get a choice. So um how it works is um so when I applied it's sort of a written um application and then an interview, and so then you have to fill in um your technical skills, and then what they do is um the HR team will match you um with a suitable project, and then they send you the briefing documents and some um overview of the project, and then you can decide whether that is a project for you or not. Um so there's no obligation that you have to go, and I think that's really important. It gives you that autonomy to say, no, that's not quite right for me at this time. They do say if you're saying that about every project that's offered, you need to actually step back and realize is this the right choice for you? Because you're going to these contexts accepting uh a degree of danger. I think that MSF is fantastic at mitigating that as best they can, and so in answer to your question, you know, of why I've not really felt unsafe, is that I do think that MSF take security very, very seriously. Um and you know, we have rules put on us when we are in those contexts that there's areas we can't go to or there's things that we can't do, or we're you know, you've got to follow those security rules. I think it just highlights it how how much time and effort um MSF actually put into ensuring that their staff are safe. And so I I've not really felt too um frightened. Um I acknowledge that you know I've been to Lebanon, I've been to India, but there are contexts that would be um more dangerous. Um so maybe I'll answer that question differently depending on where I go to next. Um but I think I take a bit of a pragmatic approach that you know um no one knows what's around the corner, and yes, you're putting yourself in more dangerous situations, but at times you're being so supported by security protocols that you probably you know aren't at home. Um and so I I've not felt unsafe at any time. Um but it is definitely a part of it of knowing that there things could escalate and um and and if that were the case, there's always evacuation options that MSF has. And I think that's what can be really challenging because you're working with a whole lot of locally hired staff and that's their home, and um you know they they wouldn't have the benefit of being able to evacuate if needs be. And so I think that's the challenge as well of of realizing that these um, you know, your colleagues become your friends and family um when you're away from your friends and family back home. So um understanding the the challenges that exist in those contexts.

Sam Miklos 28:59

So, how does um your work at MSF then work in with your work back home?

Making Doctors Without Borders Work With Home Life

Dr Justine Cain 29:06

That has been a challenge work since 2019. Yeah, um when we were saying, you know, was I ready? And I think that was um another interesting thing with general practice is that I also found um a little bit harder to go away for long periods of time as a GP. I think that your patients do expect you to be available and you know when they get comfortable with you as their their GP, um, you know, it can be really upsetting for some patients when you leave. Um, and so I guess that's what I also factored in in terms of what can I do to still do the work that I want to do and be able to afford to go over and work with MSF, and that's how I sort of moved a bit more into emergency medicine and doing locum work, and uh then I sort of deviated a little bit into medical education, so um working um yeah, with um I guess developing more of this portfolio of doing a little bit of different things. So most recently I've been working in urgent care, and so that's a really great uh combination of a bit of general practice and a bit of emergency department. And because you don't have that continuity of care with your patients, um you're able to go away for longer periods of time without it being as disruptive. So I went back to Lebanon last year, and um my employer was very, very nice and gave me six months uh leave without pay for me to be able to go over and um do some more work with MSF. Um so it's a bit of a balance, I would say that being a doctor, you you know, with a broad skill set and being quite employable, that does give me a lot of privilege to to do um to go away for six months and then come back and still have work. Um it might be more difficult in in other um careers, but certainly I think that having um you know a supportive employer is very useful and the ability to do locum work and things has been very helpful as well.

Kate Coomber 31:12

Yeah, I think that's a real benefit, isn't it? And it sounds like it sounds like you know you talked to a little bit about doing some locum work in NT and things like that. I guess if someone is listening and that they're thinking, oh, I've always wanted to do this, but uh but maybe they don't have the skills as yet. Like what advice can you give them to see how do we what what steps can they take to make sure they do? Is it is it about the adaptability of doing locum work in remote locations here in Australia? Is it is it working in emergency or or primary care? What advice would you give?

Dr Justine Cain 31:43

I think um for me the first thing would be that um even though it's called Doctors Without Borders, it doesn't uh as an organisation just recruit doctors, and I think that's one of the um big misconceptions that you you know people think they have to be a doctor in order to to work for the organization. Um so you know it's not just doctors, it you know, it's pharmacists, it's psychologists, it's um, you know, our logistics team, it's HR, it's finance, there's such a large group of people that own nursing, allied health. So um a really broad range of people that they're looking for. Um so that would be the first thing. You don't just have to be a doctor. There's lots of profiles that they look for. Um I think the second thing would be having a look at the website. So the MSF website has you know, who are we looking for? And that I found that very useful because it goes through an essential criterion and a desirable criteria, and it can really, you know, let you think, okay, do I tick off some of those things? What sort of things might make me more employable for something like MSF? I think generally, if you're well travelled, if you've worked in low resource settings, that's helpful. If you speak another language, that's helpful. Um, but again, I I I mean I'm not a HR person, but I don't think um, you know, you need to tick every single box. Um, I think you know those skills that we spoke about in terms of flexibility and adaptability are just as important as the technical skills as well, because things can shift and change very quickly in humanitarian um contexts. So I think the website's a really good and and useful start. And I think don't be deterred by the nine to twelve months initial commitment. I think it does depend a little bit on your your um career profile, and you know, if uh you know you're working as a obstetrician or you know, an anetherist or a surgeon, um something of that nature, then MSF certainly would be um supportive of a shorter initial um um project or or assignment. Um don't quote me on that, I guess I'm not HM and that's what I but certainly I think there is that flexibility because people know that it is hard to take nine months off your job and um and uh your life back home. So I think um yeah, but getting in a good position to know that yeah things shift and change when you work for MSF and um that it is important to I guess not just be ready technically but ready in terms of all of those other um skills that we spoke about.

Portfolio Careers

Sam Miklos 34:26

Justine, when you reflect back on your career and you think to, you know, medical school when everyone had that specialty in mind and they were and then you had to take your sabbatical with where you are now um collecting like a portfolio of experiences, you know, how do you how do you feel looking back on Yeah, I mean I still don't know what I want to do when I'm gonna be able to do it.

Dr Justine Cain 34:52

But no, I I'm in a much better place about it, and I think that I would love to share that as well. That I think there's so much pressure when you just start, you know, you need to you need to select a specialty and go to the right hospital, go to the right hospital, talk to the right people, do this, do that. And the reality is is that if you choose a specialty that's not suitable for you, then you've invested a lot of time, a lot of effort going down the wrong path. So it's better to take a bit of time to realise that the specialty will still be there in a few years' time, um, and that in medicine there's no substitute for that experience that you gain. So you know, I look back now and I think that I was very stressed at the time of not knowing, oh my gosh, what do I what am I gonna do? Um but now I'm much more relaxed about that because um, you know, I think that yeah, people I guess when I talk to people, they say, Oh, you know, what are you up to now? And you know, it's a little bit of an atypical path, but it's a path that's led me down to many amazing experiences and different experiences, and just sort of saying yes to stuff and giving it a go, and um and I'm still figuring out that path, and so who knows what the next 10 or 20 years will be like trying different things. Um but I would say that yeah, I'm I'm proud now looking back that I've just done my own thing. Um, but yeah, it it has come with those challenges because you are sort of going slightly differently to what a lot of people do, which is pick a specialty, go through that specialty training pathway, and then work as a specialist in that in that area for decades. So um all are valid. Mine's just been a little bit different to that.

Sam Miklos 36:37

It's great to hear that too, because I think I guess one of the the reasons we wanted to have the podcast too is to share stories like this. So that you know, someone in in medical school might hear that and go, it's actually okay, I'm not feeling like I am gonna spend decades in this one specialty, or I didn't know this kind of work existed, and how would I navigate now a few years down the line to get there? So it's great to hear stories like yours.

Kate Coomber 37:00

And even to now to say, I'm not sure what's next half of you. Yeah, and I'm still working on it. I guess what we could guarantee is it's gonna be varied. Yeah, and it's gonna have some real interest pieces, and you can see how passionate you are about the work that you do and that you've done, which is beautiful to see.

Sam Miklos 37:16

I was gonna ask that. Do you feel as um like the sense of satisfaction and purpose? Do you think it feels stronger because you've been able to do all of these different things?

Dr Justine Cain 37:27

Yeah, I I I think so. I I think um, you know, I as I said I loved um medicine and I loved med school, and then you know, when you're working as a junior doctor, there's challenges there in in terms of you know, of is this what I want to be doing? Is have I made the right choice because I had a career before I I went into medicine. Um and I think I remember being on my first assignment in Lebanon, and I remember thinking this is why I did medicine, this is this is what I want to be doing. And I decided I was just gonna do back-to-back MSF assignments. Um, and then it was really interesting when I came home. I realized that you know it's probably wasn't um financially able to just do back-to-back assignments. So then that's when I started to shift to say, okay, well, how can I create this life where I can go away every couple of years and do some MSF, some work with MSF. Um, so yeah, I think um that gives me some purpose to sort of try and align things that enable me to be able to go away with them again. And and so I've completed three assignments now and I'm definitely excited for the the next one and the next one and the next one because I think there's so much need in the world if you look around in terms of all the humanitarian crises that uh you know sadly um feel like they're getting worse rather than better. Um, and so there's great need there. So I want to keep working towards um being able to provide that little little bit of um support that I can.

Sam Miklos 39:04

Justine, um you know, you've worked locally and globally. Is there one common theme that you see that you think, you know, if we could just fix that, it would lead to just better health outcomes globally? Or is that just too heavy?

Dr Justine Cain 39:18

Um I think if there was one thing that could fix everything, uh it would be fixed. I mean, I think that's huge. Many social determinants of health and I think studying tropical medicine and public health, and you just realise how complex and how complicated it is, and um that it's not just a simple odd if we fix this, that will fix everything. Uh I think that you know going back to some more basics of international humanitarian law would be a really great start in terms of just realising we're all human beings. Um bless you. Um that yeah, we're all human beings and you know treating each other fairly and respectfully and um you know there are a lot of the principles of MSF, I suppose, and um I think working towards that. Um I think ensuring, you know, just basic health care at the end of the day, you know, that people have access to water would make a huge difference globally. Um have access to appropriate sanitation would make a huge, huge difference globally. Um you know, I I think for me it's it's not necessarily the amazing, you know, technical and fancy aspects, it's really just going back to the basics. Um and I think as well of you know ensuring that people have their autonomy over their health care as well, and um, you know, uh people being able to make choices um for their own healthcare and being supported in those choices is really important as well. So yeah, but no no simple.

Sam Miklos 40:57

No, but it's interesting, like it is just the basics, and and that was that was probably more what I was thinking is you know when you're looking globally like it might be those, it's not necessarily the tech and all of those things, it's just the basics.

Kate Coomber 41:08

And good people who want to do this great work. Yeah, you know, I think it's making sure that we've got people still attracted to work in healthcare and wanting to do things like this.

Dr Justine Cain 41:18

But people on the ground, you know, the locally hired staff that are there that live in these contexts and and the work they do is just incredible, and um so you know, supporting that as well, I think it's really important.

Kate Coomber 41:31

Yeah, community really shines through to me when you speak of everywhere that you've been and really building and feeling a part of a community. Absolutely. Yeah, that's really really clear. So with your episode, CMR will always make a donation to a charity of your choice. Where can we donate to it?

Dr Justine Cain 41:47

Oh no no no surprises here. Um so yes, I would love um, yeah, that's very very kind. Um but uh MSF, I I think um yeah, for people listening that can't, you know, or are not in a position that they can, you know, work for MSF. There's obviously I see firsthand where the donation goes and and the work that is getting done in contexts that are really challenging and really difficult. And um so yeah, donation to MSF would be amazing. So thank you.

Sam Miklos 42:19

Thank you so much, Justine, for your time today. It's just been incredible to hear your story, and I think you're right now the world is is in a really tricky place at the moment, and to be able to shine a light on the work that MSF does, you know, and hopefully encourage more incredible people like yourself to go and and volunteer and support and work in these places is is amazing. And equally just for the medical students, it's so inspirational to hear about an atypical portfolio career.

Dr Justine Cain 42:47

A typical portfolio career, I love it.

Sam Miklos 42:50

I've always started the trend. Um but yeah, like how inspiring and and you know, as someone who I think, you know, when I had started my career in healthcare and occasional therapy, I didn't end up following a typical career, and and I definitely am very passionate about hearing these stories and inspiring others to follow and say yes to all of those things that present because you just never know where you think you're going and where you end up. It's where you're meant to be. So thank you.

Dr Justine Cain 43:15

No, thank you so much for having me this morning.

Speaker 3 43:19

We care for the land and sea

Kate Coomber 43:23

We acknowledge the traditional custodians of the land of which we meet, who for centuries have shared ancient methods of healing and cared for their communities. We pay our respects to elders past and present.