THE ADAM BUXTON PODCAST - EP.210 - JAVID ABDELMONEIM (OF MSF)

Episode Date: October 26, 2023

Adam talks with British born physician Javid Abdelmoneim about why working in an NHS A&E department was more stressful than working in war and disease zones with MSF. Javid also talks about his time treating people caught up in the war in Ukraine in 2022 and the West African Ebola crisis in 2014 as well as the emotional cost of the work that Javid does and how it affects his relationships back home. And there's some haemorrhoid chat too. He told me about his time working in Ukraine at the beginning of the war in 2022 and how spiritual comfort came to him from un unlikely sourceFor more information about MSF (Médecins Sans Frontières) or to make a donation please visit:msf.org.uk/javidThis episode was recorded face to face in London on July 27th, 2022Thanks to Séamus Murphy-Mitchell for production support and to Becca Bryers for additional conversation editingPodcast artwork by Helen GreenNORD VPN DISCOUNT HERE!RELATED LINKSTHE SEXY JESUS CARD THE CLOWN MEN GAVE JAVID - 2022 (INSTAGRAM)JAVID ON TWITTERJAVID TALKS ABOUT HIS WORK WITH MSF IN SOUTH SUDAN - THE FLYING DOCTOR - 2014 (YOUTUBE)EBOLA REFLECTIONS: THEM NOT US - JAVID ABDELMONEIM (TEDxATHENS) - 2015 (YOUTUBE)Javid talks about his experiences treating patients in West Africa during the 2014 - 2016 Ebola epidemic and considers the indifference to the suffering that he saw from the rest of the world.CONTAINS UPSETTING DESCRIPTIONSFERGAL KEANE: LIVING WITH PTSD - 2022 (BBC i-PLAYER) Hosted on Acast. See acast.com/privacy for more information.

Rosie, let's go for a night walk. It's night outside. Do you want to go for a night walk? I'm on the sofa, having a great sofa time. Why on earth do you think I would go for a night walk? Just, I don't know, novelty? No thank you. You go, I'll keep the sofa warm. Alright. See you later Come on, last chance, night walk Bye bye I added one more podcast

To the giant podcast bin Now you have plucked That podcast out and started Listening I took my microphone and found some human Folk Then I recorded all the noises while we spoke. My name is Adam Buxton, I'm a man.

I want you to enjoy this, that's the plan. Hey, how you doing, podcats? It's Adam Buxton here, on a moonlit farm track, on a cold, still night, out here in the Norfolk countryside, in the east of England, towards the end of October 2023. Moon is nearly full and shining brightly in the starlit sky. The sun went down about an hour ago. It's cold, I can see my breath. Rosie, my best Whippet Poodle Cross dog friend, was absolutely against the whole going for a walk at night project.

Fair enough, I suppose. I was planning to record this introduction this afternoon when it was lovely and sunny, but I had to go into town to do some very boring admin, thinking that it would take me half an hour or so. Wrong. Sat in a superliminal style waiting room space for well a couple of hours all told including the consultation with the person in the place and at the end of it I was none the wiser it was a total waste of time but anyway I got a sunny cycle in so it's not so bad is it but look let me tell you a little bit about this podcast which is number 210 and this one features a kind of emotional ramble with javid abdelmonaim the british-born physician occasional tv presenter and long-time worker for Médecins Sans Frontières, Doctors Without Borders. MSF are a charity that provides humanitarian medical care in countries where people have been affected by wars and endemic diseases,

i.e. diseases that affect one particular area. MSF is a non-governmental organisation that relies on private donations for its funding, and they are currently running a conflict appeal to help support their work around the world, including places like South Sudan, Yemen, the Democratic Republic of Congo, and Gaza and the rest of Palestine. If you're wondering why MSF aren't in Israel, it's not for political reasons. They offered to help in Israel after the Hamas attacks, but Israel's emergency and medical services are currently in a far better state than they are in Palestine, especially in Gaza. And MSF go where they are needed most.

If you'd like to know more about what MSF does or if you're able to make a donation to help support their work providing care for people across the world there's a link in the description msf.org.uk slash javid. So let me give you some javid facts this conversation with him is not simply a fundraising exercise. It's a conversation with an extraordinary guy who has and continues to do some amazing work across the world. Javid was born in Cambridge, England in 1979 to Sudanese-Iranian parents and went to medical school at UCL, graduating in 2003. He spent several years working in the NHS as an A&E trauma doctor, but is now working full-time for MSF. He was president of MSF UK from 2017 to 2021. Javed has worked for MSF in places that include Haiti, Iraq, Syria, West Africa,

and he was the doctor on board the MSF and SOS Mediterranean search and rescue ship Aquarius, where he provided care for people rescued by the ship in the Mediterranean. In 2014, Javid travelled to Sierra Leone in West Africa with MSF and there he treated patients at the start of the Ebola epidemic. During this time in Sierra Leone Javid featured in the BBC Panorama documentary Ebola Frontline and in 2015 he delivered a TED talk to which you will find a link in the description if you're interested, about his experience treating patients in West Africa and the indifference that he saw from the rest of the world when it came to the suffering there. Javid has also presented many health and well-being related TV programmes on BBC One, Two and Four,

as well as Channel Four and Al Jazeera. My conversation with Javid was recorded face to face on a hot day towards the end of July last year, 2022, in Javid's small but nice top floor apartment in Kilburn, West London, soon after he had returned from working with MSF in Ukraine. We had the windows open. So now and then you will hear some noise from children in the street below. I'm sorry about that. Obviously, I screamed at them to be quiet. I hurled some abuse and threatened them. They just carried on.

There was nothing I could do. Meanwhile, Javid told me why working in an NHS A&E department was more stressful than working in a war zone, which somehow led us to comparing notes on hemorrhoids. I'm sorry about that. I always seem to gravitate to that area one way or another. Javid also told me about his time working in Ukraine at the beginning of the war in 2022 and how spiritual comfort came to him from an unlikely source. We also spoke about the emotional cost of the work that Javid does and how it affects his relationships back home. But we began by talking about what Javid had for breakfast. It's the classic, what did you have for breakfast?

Soundcheck start. I'll be back at the end of the podcast for a little bit more waffle and to say goodbye. But right now, with Javid Abdelmonem, here we go. Ramble chat, let's have a ramble chat. We'll focus first on this Then concentrate on that Come on, let's chew the fat And have a Ramble Chat Put on your conversation coat

And find your talking hat Yes, yes, yes La, la, la, la, la, la La, la, la, la, la, la La, la, la, la, la, la, la recording chad would you just yeah would you like me to do the old uh what do you have for breakfast thing how about that today i actually had a bacon butty today believe it or not my cousins stayed in the flat while i was away and they left some bacon in the fridge so being a good muslim uh i wouldn't i didn't want to throw it away and i made myself a bacon butty which is very naughty to be honest so it wasn't even faking or anything

like that would you normally be are you normally vegetarian or anything listen i was until the pandemic came and then that changed everything didn't it the pandemic changed everything here we go i can definitely say that i never used to drink alcohol at home yeah i had been plant-based exclusively for a year and everything just changed it's like no I'm going to go back to eating meat and I went through a really strong heavy phase of drinking a lot at home through through lockdowns and have actually struggled to get back to pre-pandemic waistlines to be honest so were you locked down or were you out and about traveling for MSF no no I was still working in the NHS then so I only was still working in the NHS then.

So I only gave up working in the NHS in December 21, this last December. So I worked COVID peaks one, two and three in the NHS here in St. Mary's and Charing Cross hospitals in West London at Imperial Trust. So I'd kept up until last Christmas a foot in both worlds, MSF and NHS, three-letter acronyms. But actually, come at the end of last year, I thought, I can't do this anymore, actually, working in the NHS. It takes a different kind of toll on me that I can't cope with. And so I find it easier and more joyful and satisfying to work for MSF. and more joyful and satisfying to work for MSF. Working in the UK for the NHS is worse than being in Sierra Leone treating people with Ebola.

Yes, for me, much worse. Why is that? It is a uniquely grinding shift, a 10-hour shift in A&E in London. And it's made all the more worse because the system has collapsed and the toll is on people. What does that look like then as far as going in, showing up for work? How do those things make themselves evident? The waiting room is packed. It's a seven-hour wait, for example, to be seen. There's a large number of patients who could have seen a gp but gps are absolutely full there are fewer doctors per person in the uk now than ever before

let's say put it that way so gps are absolutely full and the backup because of the pandemic so patients who needed to see their specialists are backed up. So outpatient departments aren't catching up. So GPs are spending longer and longer time seeing the much more complex cases that they shouldn't have to see because they're normally seen by specialists and outpatients, but they're waiting too long. So they have to be the safety net for them.

So A&E, the doors never shut, becomes the safety net for everybody else who would normally see their GP. The system's collapsing, collapsed. It's gone. We're not going to be able to pull it back. When was it better? Was it ever better? Listen, it's just been this sort of, it's a grey transition, isn't it? When was it better? It was better before. When was before? The fact of the matter is we have more people living longer with more complex diseases but we have per person fewer doctors fewer acute hospital beds the funding simply does not match what we need to get done we always had another gear as the workforce we always had another gear will you do

this extra shift of course will you stay late will? Will you miss your break? All the time. All the time. But after the pandemic, and for me personally, after the third peak, I don't have it in me. And every single one of my colleagues has an exit plan. Every single one of my colleagues can't do that extra shift. It's suffocating. It's brutal. Yeah. Do you think about scenarios for how to improve it? Is there a world in which it would be a good thing for some cabal of billionaires to come along and just lob money at it? Would that be helpful? But at the end of the day, the maths does not add up. You know, one way of being hopeful, a friend of mine who is, this is very funny, I love him. We graduated together. He says, as soon as the boomers pop their clogs and the population bulge just comes back to something a bit more realistic, it'll be fine. And I'm like, OK, I'll just wait 20 years.

So that's quite funny. He looks at it that way from a population type of level. And it makes me giggle when I think about it, because you can just sort of talk about it in that sense. But the here and now, it's frightening. And you know, you could talk about climate in the same sense, actually. It's like, we're sort of frogs in boiling water about it. But the answer is, of course, I'm going to say more money, more staff, recruiting staff from abroad. Has that been made more difficult by Brexit? Of course, it's been made more difficult by Brexit. We had lots of Spanish and Italian staff members in my emergency department in West London who, after Brexit, said that they stuck at it a year or two and have gone. But also foreign workers full stop from Africa, from Philippines especially. Getting visas is more

difficult. All of these types of things that are barriers that have been put in place to take back control are actually make it harder to resource the NHS with humans. And then is it a great advert to hear that GPs overstretched and constantly being bashed? Do you think a young medical student's going to go, oh yes, I want to be a GP? Of course not. So how do you think a young medical student's going to go oh yes i want to be a gp of course not so how do you change that narrative as well the narrative for gps is they're working the hardest they've ever worked they're seeing more patients than ever and they're being told to provide services that on the whole a lot of patients don't want to see a gp on saturday they want their weekend off and then they're pushing them towards pharmacies now right yes but pharmacies have always been there, pharmacists.

And it's one of these brilliant things that people don't really know about, that pharmacists, it's a four-year or five-year course, depending on what you do. They're fully trained in seeing all of these sort of minor things. So if you sprained your ankle, you have a sore throat, you have a headache, your first stop can well be a pharmacist, and they can prescribe you medicines that aren't off the shelf. They're over the counter. So there's three tiers of medicines in the country, aren't there? There's what you can get off the shelf. There's over the

counter, which is prescribed by a pharmacist after a consultation. Then there's your GP or your doctor's prescribed medicine. So that's an asset that the nhs has always had that's i think chronically underused and you'll find loads of adverts you know trying to get people to be seen at the right port of call right it's not to divert people from a and e yeah it's about being in the right place and knowing how to so that's what a lot of the stuff i do with patients when i was in a and e was actually telling them about how to avoid a six-hour wait or how to get a referral better or what these are the things you need to say to your GP to help them really understand what your problems are and almost coaching them how to get the best out of the NHS which is something I

think a lot of patients don't know how to do and why should they because you're told to take things seriously so you've got some blood in the stool absolutely i better go in yeah see someone see someone because it could be because you go online and you go blood in the stool and then you get this fearsome litany of possible yeah causes frightening ones as well yeah very frightening ones so i get that i get that and when i was younger i used to bluster my way through the waiting room and just waiting listen oh you shouldn't be here it's completely unfair if any doctor said that to anyone any one of my friends i'd say you go back in there turn them off because in their world they needed to be there so what's the hack for blood in the stool guy now everyone's imagining

me with blood in my stool you've talked about colonoscopies before haven't you i think hey look it's happened sure for me it turned out to be i mean we're going this is too much information for a lot of you and i apologize listeners but i'm trying to be candid here but you know for me it was like hemorrhoids but the first time you see you know you sort of wipe and it's like oh my god it's blood that's bad bad. You immediately think, okay, I've got rectal cancer or whatever. But I imagine there's so many of those kinds of things, whether it's up your bum or whatever, that could be lots of quite scary things that people think, shit, I've got to get into A&E. What is the best way actually for the NHS, for those people to

behave? From my perspective, having seen a little bit of blood on your tissue is not an accident or an emergency, right? So you need to go and see a GP. From your perspective, you probably have a three week wait. And you don't, that is not something you want to wait three weeks from because you'd read something on Google and it'll say, oh my God, get this checked out, get this checked out. There is actually no answer. There is no answer. So you've done the right thing from your perspective. But that's because the structure and everything that's the health sort of ecosystem in the UK at the moment is ever say you shouldn't come here for this. They're damn right thinking it probably, but they should never say it. It's just about educating them and saying, right, next time, this next time, that next time, this, if that, if that be here, go there, do this. It's all just education and signposting.

Yeah. So that's it. I mean, yeah, I mean, if just about I am. No, I'm not going to tell you. I went on a flight to the first time I flew to Australia. You know, you're sitting down for a very long time. The inevitable happened. I'm not, I'm not, I've gone bright red, but the inevitable happened.

And I was a bit like, oh God, I'm going to have to go to a pharmacist. So I went to a pharmacist and got some cream. And, and it was just so embarrassing because the man out loud with no sense of shame which i was feeling in in huge huge amounts was like oh don't worry we've all had it one time and we'll all have it you know everyone in the world either has it now or has had it or will have it i'm just like oh my god this is so embarrassing just to be clear because we're all imagining all sorts of things now hemorrorrhoids. Yeah. Yeah.

God, that's OK. Piles. Come on, you're an A&E doctor. It's made me go bright red. Because are we all supposed to be sort of healthy sorts, aren't we? Where, I don't know, the sun shines out our bottoms or something. After a certain age, especially. You get on a 12-hour flight.

There you go. My friend the other day was saying he's a musician and he flies around quite a lot touring right and he says uh best thing i ever learned don't eat on the plane like just don't he's up there in first class being flown around would you like your meal sir have you chosen from the menu and you said if they have be good to take advantage of all this luxury yeah but actually he says now you just drink a bit of water and really don't don't eat as much as you can that'll that's your best chance of being regular when you get to your destination otherwise you get all backed up sorry i've taken this all in a very bottom well i mean you know bowels and all of

that we're all regulated by i don't get jet lag when i fly somewhere to australia i get bowel lag so i'm so regular that that's what takes ages to catch up so suddenly i'll be out in australia it happens at four in the afternoon it's just the worst possible time but yeah there you go why do you think then i don't want to make this too political because obviously it's not just the tories i mean no one seems able to effectively help the NHS in any significant way. Why is it not more of a priority? And this may sound like a very naive question, but you would think like everyone cares about that. Campaigns are always fought about how the NHS is going to be funded. It's always a big part of electoral policy promises so why is it not a question of just making it a huge priority to properly pay nhs employees and to properly fund hospitals and

build new ones um well i mean they just lie sorry to say they say we're funding 12 new or how what number was 30 new hospitals and sajid jav when he was health minister, went to one of these new hospitals. Is it a new hospital? They've repainted four walls and put a new door in to one wing and called that a new hospital. It's not a new hospital. It's actually not a new hospital. Don't lie. We're not stupid.

And it's sort of the callousness and sort of brazen nature of their lies about we're more funding than ever. No, you're not. It's actually just not true. You know, they've had 12 years we've had of a Tory government. Yeah. And, you know, you can look at statistics from Labour's sort of Blair era about what was injected and what changed. It's just a completely different landscape for us having a tory government completely they're just ideologically opposed to having a well-functioning nhs because they see it as an entire sector of the economy that has been closed to private industry huge amount of money to be made and and they've been working to have it collapse there's this isn't me saying

it's some sort of corbinista type labor voter or something it is the evidence that i see in front of my eyes and it's just getting worse and worse and worse and worse and i come back to it like the strain finally falls on the staff because we want to deliver what we want to deliver and yeah there comes a line for each person so I crossed my line um last year and now as I speak to you we are coming towards the end of July 2022 and you've just been in Ukraine yes how long were you there for I was four months out of my door so I left on March 21st that was just before the war started just after no the war started February 24th so it was coming up to the like at the end of the first full month of the war it was before um he sort of withdrew forces from Kiev and everywhere and said I'm now concentrating on the east it was before that

but anyway I spent four months and came back just last week and what were you doing out there you were there with MSF yes yes I was there with MSF so I'm you know I'm emergency medicine specialist so I knew that I'd be going to probably the most hot spots around so we had projects in Kiev but I actually went to Kharkiv which is in the far east it's the second biggest city of Ukraine and there we did mobile clinics doing primary health care and mental health care with psychologists as well for people who were living in shelters initially in the first two months it's people who are living in the metro because the metro there they're built as nuclear bunkers so running water very, very, very deep, electricity, mobile network,

and just thousands of people have taken to living in the metro when the war was really bad in Kharkiv. And the metro then stopped in the state, the trains parked up. And so people were living in tents and on mattresses in the trains, on the platforms, through the entire metro network and wouldn't go above ground if they were in two of the areas were really really heavily shelled inside the city because they hoped they might just be able to wait out the worst of the war and then return to their homes if they were still

standing absolutely and that's exactly what happened so as things sort of cooled down around mid-may certainly sort of the front lines were pushed back towards the Russian border, which isn't very far away, 70, 80 kilometers. The city was then out of range of shelling and life really slowly started to return. It's quite a big city. It's about 1.5 million people. And now people are just back in their houses trying to get on with life a little bit. It's been five months of the war. And so with life a little bit. I mean, it's been five months of the war. And so people are a little bit sort of like, we need to live our lives.

Certainly the city has got a different level of shelling now compared to, I mean, in April, it was all day, every day. Constant, constant, all day, every day, you know? But now it's far fewer. A little bit unpredictable. There was always a pattern. If you really stop stop and look there's always a pattern to a lot of these things ironically or not and the pattern changed in the last month and some became at 4 a.m some came at 10 a.m and then you're a bit like oh it's now in that area well maybe we won't go there this week to do a mobile clinic in that area we'll concentrate in this area and that's how you sort of stay safe. It's more about avoidance. If you just sort of really carefully watch what's

being shelled when and at what time of day, then you can quite successfully so far touch with that goodness with all our teams, avoid being in the wrong place at the wrong time. And are you working with local medical practitioners there? And are there other NGOs out there as well? Or how does it all work? Oh, it's really variable where you are in Ukraine, depending on security levels, who's then there, right? So I found that in Kharkiv, we were very nearly the only international organisation

working there in all these months. Many would come, try to come, would make their analysis and decide that they couldn't safely stay. We had Ukrainian staff, Ukrainian doctors, pharmacists, psychologists running the mobile clinics. In the early days, it was all sort of me and one other doctor just doing it all. And the psychologist was Italian. The other doctor was Norwegian. Another doctor came that was Australian. So we were as foreign as doing the consultations through translators but as we got more established wanted to get a bit bigger wanted to run a few more mobile clinics and also it's

better just to have a you know a consultation a doctor or a psychologist in your own language it's better so we actually were able to recruit staff some of the doctors their own hospitals were no longer functioning for various reasons some of them were just between jobs wanted to stay and volunteer and sort of work for the war efforts in the best way they know how which is by being a doctor so we built a really really really amazing team there and we're doing mobile clinics now out in villages out towards front lines in places where a lot of organizations won't go and sort of if you go east and north of harkiv which is really towards front lines then you'll have fewer organizations but i also want to shout out for the volunteer organizations like civil

society groups that have been there throughout just doing so much of the work like running hot lines running medicines to people running food running hygiene items distributing things door to door some of them going really really into hot areas you know that's just an amazing phenomenon so it's been great to be able to work with them also together we can support each other really if they say right this is an area we've been to we've seen there are x and y needs there like what and we say well okay what do you need what are you going to distribute we'll piggyback on your distribution with x and y other stuff to complement that or we'll send a clinic with you which is a doctor and a psychologist see the patients come back that type of thing really symbiotic it's really quite quite special does

msf then have a different risk assessment threshold from other organizations or how does it work it's difficult one to to answer i think there's a certain benefit that comes from having got in and stayed in uninterrupted since march in that city so you have that sort of visibility contacts network and institutional memory coming in now and not having any of that background it's quite a hard barrier to to overcome you know and so i think that's it and that there comes you know the risk benefit the analysis that you make for us very much right there at the end of march i mean i took the night train it was the refugee going east, so going in the wrong direction from Wienitzer all the way. And it was under cover of dark, total blackout. Couldn't see my hand very quietly.

You can feel it was going slowly through the night. You did feel like, gosh, like, what are we going into here? Yeah, yeah, yeah. Arriving there. But if you do a risk calculation about exposure, about being above ground versus in a bunker or in a nuclear shelter, which are the metro stations, you're really quite safe when you're below ground. And the exposure risk window is just the time that it takes to come out your bunker, get in a car, go to the metro and go back down. solidarity for the being there with those people which i think we in msf really value being there shoulder to shoulder with everybody to witness to experience to support i think that that risk benefit calculation fell on the side of yes we're going to do that yeah and we chose to sleep in the metro overnight every night carrying our backpacks carrying our medicines carrying our water and consult as many patients whoever comes just sit there say here we are i'm a doctor

and just consult the patients for whatever they ailment they had and if i had the medicine they needed here's a month's supply and they burst into tears like oh you know running out of money don't want to go above ground don't even know if it'll be in the pharmacy don't worry it's right here here's a month's supply it's amazing and and then actually then going you know somewhere around midnight maybe a bit earlier you finish with your last patient and unroll your sleeping bag and sleep right there on the platform and get up at six in the morning and leave i thought you're gonna say then you go clubbing no there might have been some clubs open i don't know um but so it's quite it's a great experience you know and to be able to say that we were there with them yeah you're carried through by those moments when you really feel that you have made a difference right

there and yeah yeah and they're human stories you know of fortitude bravery courage resilience all of these words that you sometimes see on those statues of world war one and two around don't you and um i really really really experienced those moments with people in these kinds of places at those times is there one that sticks in your mind from your recent trip from ukraine i will tell you one um i only met them very briefly. We were trying to get goods into a city in the east that was being besieged and pummeled. I had a contact who said that they needed X and Y medicines and I got the supply together and needed to get it in. And at the last minute, we called off physically going ourselves just too much shelling yeah too unsafe and the people that who were to receive it said don't worry these people who are coming to evacuate some people from our shelter are leaving from your city today meet up with them give them the goods they'll take it in for you it's like great because here we weren't asking someone to make a journey that we wouldn't

they were going to do it anyway they were going in to take evacuees and take them out. And they were perfectly happy to take these medicines in. And I met them and it was literally a priest. Literally a priest in his full sort of orthodox cassock with this great big cross hanging off his neck and two clowns. You can't make it up, Adam. A priest and two clowns. And you just it's the beginning of a joke isn't it i think they were a gay couple actually they were a spanish man and a ukrainian man and we were

nowhere near harkiv at this time i was actually out on what we call an explode truck in needs assessment exploration but he was originally from harkiv and i knew the building that he lived in and he told me on the first day of the war we saw fighter jets fly right past our window and we thought to ourselves can't stay here so we moved to Dnipro we were near Dnipro at the time big city in the south and from here we've been doing this we've been running any items that people need in and evacuating people out they were just two professional clowns so they stuffed their floppy shoes with pills can you imagine and it's just like the bravery and the dedication you know

and you're just like whoa and they gave me this little hand-drawn image of jesus on a card and he kept saying every day is a miracle for us it's a miracle we get down that road it's a miracle we get to that city it's a miracle we get those people out it's a miracle and it's cynical me was like bloody hell if your entire security analysis is that it's a miracle and get those people out it's a miracle and it's cynical me was like bloody hell if your entire security analysis is that it's a miracle and you're praying to jesus i'm like that's a bit dodgy as far as i'm concerned but anyway good for them yeah whatever works whatever jesus powers hey that's a good looking jesus he's a very good looking jesus isn't he yeah who does he look like he looks like someone sexy and famous that's exactly what he

looks like someone sexy and famous he really does look at his hair but on the back there's this whole sort of blurb about a cosmic battle and i'm like rolling my eyes whatever whatever and right at the bottom it says jesus come into my heart forgive my faults and fill me with your spirit and then And I don't know why I'm getting emotional right now reading that. I didn't expect that to happen. But it really struck a chord that these two clowns, middle-aged men, were doing this. Yeah, man. two clowns middle-aged men were doing this yeah man so i think about them a lot and i i half want to call the number to see if they're still alive to be honest but i don't want to find out that they're not so i don't but that that thing helped me to do my part to leave this world better than

i found it is definitely what they were doing and it's something that really strikes a chord with me yeah yeah and it's something that really strikes a chord with me. Yeah. Yeah. so you used to be a trauma doctor right yeah emergency medicine and i did a lot of trauma i worked in a major trauma center here in a and e yeah and in that context the definition of trauma is something physical yes yeah but in a wider more conventional context people think of trauma as you know a terrible accident or an assault or experiencing a natural disaster, something like that, and living through it. And then usually that results in some form of PTSD for a lot of people. And so that must be a central part of your life. I mean, whether you actually experience the physical effects of the environments

that you're in or not you are seeing the effects of these disasters or these war zones i'm thinking of fergal keen the war reporter who stopped covering wars because he said he was he'd been diagnosed with ptsd i think i saw that yeah and i have a friend as well who's a reporter who went to cover the aftermath of the earthquake in haiti in 2010 yeah you were out there as well yes and he's like a real gung-ho robust super solid guy and he was upset at the time but only now is he sort of facing up to the effect of it for him it hit him during the lockdown when a lot of people suddenly had time to process things that perhaps they hadn't done before so how is that aspect of the job for you and how do you deal with all that i think there's no doubt that I've been affected by all of these things.

And after Haiti, maybe three years after Haiti, it hit me. And then after Ebola, the following summer again. Why was Haiti so bad? It was the first time I'd been exposed to that level of avoidable death. I'm not talking about the earthquake, I'm talking about just the healthcare system afterwards and also the cholera epidemic. I was tired, I'd been in Iraq for six months anyway, I was overloaded, I had a huge team to manage, it was my first mission in French, had a terrible supervisor, so lots and lots of factors and if I look back now, I can find the words. There was this constant sense of overwhelm and helplessness and just a sense of, yeah, avoidable death all day, every day. Deaths that simply wouldn't have happened in my practice and had not happened in any of my practice back in England up until that point. So that takes its toll.

And you just soldier on and get on with it and soldier on. You work six and a half days a week, six months, and you just get on with it on with it and soldier on you work six and a half days a week six months and you just get on with it get on with it with your night shifts and everything and then cholera comes and actually it was exciting it was high octane high emergency let's get this done volunteer for all the extra shifts gonna do it we're gonna do this build a cholera tent in the in the car park yeah but but just death so much of it i can't explain it any other way just too much death death and yeah it hit me afterwards and i knew it would be the same in ebola but i was prepared but it still hit me and i've realized the things that make me a good doctor

are precisely the things that make me need to walk away from it. Is that I soak up all of a patient who's in front of me, all their anxiety, pain, despair, worry, grief, stress, anger, which is the constant emotion in an A&E waiting room. I soak that up and i'm that person walks away smiling thank you doctor you're lovely you're amazing it takes a toll on me sure and i found that i have a very limited capacity i can't work full time for example in an nhs right really if i could do three days a week for three weeks and then I need a week off and that's just about where my

empathy bank can tolerate before being drained if I go beyond that forget it I fall apart like physically mentally just fall apart and then I go to a very black place where even my inner voice stops talking utter silence and are you able to sort of describe the nature of that blackness is that sadness or fear or it's an absence of any emotional sound it's a total blackness devoid of emotion because it's just drained me so i have this empathy bank that's credited and debited each day and on the whole a credit is being alone don't come near me i need a day alone and debit is being a doctor but in msf it's not that case it's the opposite i don't get that debit from my msf work but i'm in those scenarios where you just are confronted with as you've said

immensely traumatizing situations and a lot of the situations which really bother me are man-made each person i have ever met has been a good person how is it that on our organized level at the level of politics or nations or even society how is it that we have such a collective capacity for destruction and and violence i can't understand i cannot understand why we declare war i can't maybe i've become a pacifist after all the things that i've seen i went to the apartheid museum once i was in south africa have you been no it really is a striking place striking i was in sobs and sobs of tears all the way through for four hours yeah and i don't know where that came from but wow and i was just now in poland and i was in krakow and i thought shall i go to auschwitz and i thought no i i i would not be able

to walk through those buildings yeah the way i'm feeling at the moment after what i've seen i was like i need to come back in a different frame of mind but the capacity for humans at the societal level to just fuck everything up yeah it's just it overwhelms me but then you you meet people like the clowns it's amazing you know so i don't i don't know where we get that lost in translation from good people and fair enough communities and neighbors to to national strategies that just like what is bolsonaro doing with that jungle you know i'm just like what are we going to do with him how how has a country elected him but then we've got boris how the hell did we elect boris and trump and i don't know all these weights of the really, really overwhelm me a lot of the time, actually.

Well, it's fear, though, isn't it? It's people. People get frightened. And when they're frightened, they want it's typically a strong man. And so you get the strong man elected because people you know they don't want to be responsible for these things themselves or they feel powerless they hand over responsibility to someone who shouts the loudest who seems the most sure because most people you know it's not like people are voting for these people because they want the world to be worse exactly exactly all of

us have that that goodness i feel yeah all of us have a wealth of resources you know internal human resources that are capacity to be kind and to be generous and to laugh and to see the bright side and see the positives and to want everything around you to be better right we all have that you know so that that migrant who wants to leave their area and go somewhere better you know no fuck that shit dump that boat that boat's not allowed here and that's why i say on the personal level on the individual even as community levels you know we're all fundamentally very good human society somehow at national level we declare wars we wage you know this that and the other trade

wars this war's migration barriers and it's just like how can we not get our shit together which should be so simple and that's where i get lost but anyway so i just stick to just keeping my head down sometimes and disengage it's easier just to disengage from all that keep my head down and just do my msf stuff which makes me happy but takes its toll has no one ever suggested that you run for office? No no I mean one day who knows I'd never say never to anything really but no. Maybe you're maybe you're too emotional to be a politician. Probably. I would imagine that doctors who do the kind of work that you do I would think that the only way they can do it is to switch everything off and is that not the case I mean

that doesn't seem to be the case with you. There is a degree of that flippancy which is a protection mechanism right and i i get that and we've all employed that as medics and maybe i need to employ it more but making the diagnosis processing the patient through their flow from entrance to exit in a and e i can do with my eyes shut. So where am I supposed to get my joy and challenge from? From the human being in front of me. Human being who felt they needed to sit in A&E for seven hours today for some reason.

So when my empathy bank is high, I engage with them as a person. And I ask all those questions. How's your sleep? How's your stress? How's your life? How's your emotions? How's your relationship?

That actually gets you 90% of the reason they're there. That back pain, that headache, that dizziness, that poor sleep. None of that needed a tablet. That needs a good talking to. Yeah.

A lot of the time, surely, maybe it's a little bit what I was saying before about politics and why people vote for these Bolsonaro type characters is reassurance and anxiety and fear. What people are looking for is for someone just to say, you're right. Certainty. Yeah, you'll be okay. Definitely. Don't worry.

This isn't too bad. You know, that's 90% of the job. Well, maybe not 90%. Like, obviously, there's a difference between someone with a broken arm and someone but someone who's just worried who's just spent too long on the internet diagnosing their own symptoms and doesn't know what the hell's going on yeah i agree with that a lot certainty is something that humans crave i crave and sometimes just making a decision even if it's not perfect is is going to be better than faffing. When you're the information holder

as a doctor and someone is coming to you because they don't have that information, which is the fundamental sort of transaction that's happening between a doctor and a patient, then you need to give them enough information for them to feel confident in whatever's happening right at that moment. So on that level, yes, it's it's about certainty of course you're dealing with in medicine a lot of gray areas and probabilities and what's more likely and less likely rather than what is certain and not but even saying yes that's much more likely or no that isn't and i think there's something about that in msf also or at least i felt it in in ukraine a lot and certainly felt it in ebola having that sort of fixed point of someone who says i'm gonna come back i'm gonna be here i'm gonna be here with

you we see you you're not unseen is something really really powerful that solidarity element yeah it's about having that sort of a fixed point amongst all this craziness isn't it right and just not feeling that you're on your own with it or that no one cares certainly and then when you are especially out in sierra leone and the survival rates for ebola are not good you're dealing with people who aren't going to make it it was it was difficult it's you know it was we were briefed very clearly that this was a almost a palliative care mission that you we didn't have a cure didn't have a treatment it's supportive management so that was a very different briefing um and yeah 40 survival rate so six out of 10 patients would die that's a lot

that's really really high and so that sort of blocking yourself off from patients until you thought they're going to be ones that survive happened i recognize now you know you'd hold their hand you'd give them the painkiller you'd give them something to drink but you almost wouldn't even want to know their name and then as soon as you felt oh they might be they're actually resurrecting because a lot of the time they'd be moribund up absolutely flat in their beds just absolutely debilitated with weakness but sometimes they'd sit up and you'd think after a couple of days or three days or whatever, and you'd think, oh, maybe they're going to survive. And then you'd get to know them a bit more as a person.

I remember so many survivors. And I don't remember, I only remember one that died, two that died, three actually. But that's odd. That's odd considering that the death rate was so high. You'd think just by statistically alone, having nursed so many. And it was mainly nursing, to be honest. Hey, I use that word intentionally. Nursed so many patients, six out of 10 of which would die. Statistically, you should remember more.

But you didn't. I didn't. I only remember three people that died because I didn't want to get attached. And it was almost a self-protection mechanism. Yeah, well, exactly. That's your mind sort of trying to hold on to some positive aspect of the whole experience, I suppose. Are there better treatments for Ebola now? Yeah, there are treatments and there are vaccines, so it's all good now. That's an example there of a neglected disease.

There is an official list of neglected tropical diseases, NTDs. And once you make it onto that list, you will actually qualify as a disease for research and funding into medicines. But there are many, many diseases that don't even make it onto that list. But neglected diseases, have you heard of this concept of neglected tropical diseases? Only through you. I watched your TED talk. Oh, okay. Yeah. So, you know, diseases, I mean, it's a sort of economical, the mechanics of economics, really, of pharmaceutical companies. If you're not going to make money from a product, they don't develop it. And unfortunately, that means diseases that affect people who live in poorer parts of the world don't have treatments.

And Ebola was one of them. But now it does. So that's good. let's look at the positive yeah absolutely it's very good could have happened earlier but there you go uh I mean look at how quickly we develop vaccine for Covid yeah very quickly it's immense immense immense achievement we're amazing when we want to be and can be but we're very selective on when we want to be and can be and that's a problem for me we were talking though about uncertainty that's the thing that people really want to avoid if they possibly can i mean post brexit britain seems likely to be unstable and unreliable for a while

train strikes understaffing especially in the nhs of course you know we at the moment we got the border chaos yeah at dover and inflation and spiraling fuel prices i get stressed when the trains are delayed my train was delayed coming to london today and i was thinking oh this is stressful i don't like not know am i gonna make it to london am i gonna have to cancel everything i don't like it but that must be your whole life sort of thing, even though, I mean, is that the way your life feels to you flying in and out of these places? I mean, you could argue that I'm just an adrenaline junkie, I suppose, but there's an element, there's definitely a huge element of uncertainty in the places that I work,

of not knowing what you're going to be doing the next day or what your activities are going to look like i mean just an example on that sort of very sort of granular daily level where i was working in harkiv our plan for that day would very much depend on where the most recent shelling has been has there been shelling on route is it safe is it not safe what are the people who are at our destination telling us should we come should we not come what should we carry with us should we take some hygiene items should we take some medication supplies who we're going to meet all of that stuff so there's a huge amount of uncertainty there i think what i hold on to the fact is that in in such an environment the certainty is at the moment that we're staying we're doing this these are we're delivering these activities

because actually we've been here for four months. We've managed to make it happen every day. If today cancels, it doesn't matter, we'll do it tomorrow. You know? Knowing when to zoom in and to zoom out and to look at, just always look for the bright side, I suppose, is what I'm saying. And if it suits me looking for the bright side on a very granular level or looking at the big picture, well, I'll do it.

And I guess you're solving problems coming at you from all angles. So you don't have the time necessarily to dwell on that feeling of uncertainty and worry, I suppose. No, and you've got to provide it for the team, right? So when you're also a team leader, as I was, I'm the medical team leader, it's your role to provide that certainty or to provide that decision making or project it so you you have to sort of soak that in have you always been good at making decisions oh listen when you're a doctor that's what you do all day every day i'm very good in resus blown up limbs in raka i've done it i'm very good in that heat of the moment deliver a decision get it done doesn't matter

we'll we'll go for it and it always it's about probabilities and likelihoods and balances and risks and benefits right outside of life my friends just look at me and they're like god you really are the most dithering what is it when you've got no common sense nonsensical ditzy yeah ditzy can't make a decision dithering oh should we do this should we we do this? Shall we not do this? I'm like this sort of different person outside of work. And a little bit of it is a little bit conscious.

You know, if I have to do all that at work, I don't want to do that outside of work. You need everything to be life or death. There's an element of that too. Like this is too banal for me to have to make this decision. Are we going to have curry or a burger for dinner? I don't want to make that decision. It's too banal for me to have to make this decision are we gonna have curry or a burger for dinner i don't want to make that decision it's not important enough i'm overwhelmed by the meaninglessness of the choice it's an element of that i can't i can't unless i'm really hungry when you're famished you can make that decision very easily yeah maybe it's not to do

that so i'm a bit different in my social life sort. I'm a bit like the ditzy stupid one in my friendship group. And I'm quite happy to be that person because I'm not allowed to be that person at work. And that's OK. How does it work having relationships, if you don't mind me asking, when you do the job you do and you're away and all these places? You know, it works. You've got to guard against an element of distancing when you're away for a very long period of time and you're creating experiences apart from your friendship group and your family then that by definition is growing separately isn't it and so you've got to guard

against that it's a little bit difficult for me because no one can really relate to what you do right in my full social network let's call it of course doctors in the nhs who i'm friends with fine we can all relate about that but about my msf work i don't have any msfers that i'm regularly a close friend of people that i will pick up the phone and see tomorrow or walk down the street now and go and see now or whatever whatever I don't have that everyone's happy to listen everyone's interested to listen that first time that you see them but after that it's a bit sort of like okay move on so it's it's really funny like you've just been somewhere now for four months with a team really close knit with a very strong sense of purpose with a team really close knit, with a very strong sense of purpose, with a very, very strong sense

of activity, togetherness, adrenaline fueled, caffeine fueled. And actually you're coming back to your normal life, but it can be, my experience has been over the years, a little bit like, actually it can be quite isolating coming back to your normal life. Sure, yeah. Nobody here knows any of that and feels any of that. So I'm conscious that I'm not good at opening up about it or I actually get a bit ratty and snarky if people ask too many questions or show me pictures. I'm like, what do you want to see pictures for? And at the same time, I should to guard against that distancing

to give them something that they can identify with. So I need to work on that a little bit just do a keynote presentation when you get back once and for all yeah i mean after the ebola it was easy they all got to watch that documentary that happened yeah and that and then people really got it you know they were like whoa they got it so after that actually things have changed people get it very much because before that i had done a few projects and I come back and you're always in a little bit of a high as well when you first come back. And then the full sort of weight of what you've just been through, for me anyway, hits you afterwards. When that initial flurry of, yeah, you're back, let's see each other.

Yeah, that landing point that comes at x period afterwards that's the really difficult part for me personally that's when the weight of everything that i've seen and done hits me in the quiet moments yeah um but i've been very lucky i've got a group of friends from school that i've known since i was 13 and then i've got university friends that i still see as well so people that i've known since I was 18 and having those people around you is is something that's just you know you can't put a value on that it's just amazing that I have all these people still around so I feel very lucky and and they get it now they understand it's good it's okay it's not ideal I wish I could do a job in England that satisfied me and didn't break my soul.

But I haven't found one. And MSF does that. It doesn't pay very well. That makes life difficult. What can I say? Yeah, well, we'll come to that. So what are the things that lift your spirits? Have you been on desert island discs? No. I imagine you getting the call at some point. I'm going to beat them to the punch. What are you going to be taking to your desert island? Oh my God. Do you like music? I do love music, but I have a very eclectic, if that's the word,

I have just a random choice of music, right? So it might even be your teeny bop, or it could be Bollywood, or it could be Arabic pop that I listen to, or just there's a lot of African music that's just wicked that you will you hear when you're out so I just pick up songs left right and center I even listen to a lot of classical music as well actually I really like Anglican choir music but strangely it's probably because I went to King's College choir school a good choir is a beautiful you know yeah and if you looked at my spotify list it literally is from a to z just the most random music and i love that i love listening to

music but really gardening is something that i just you know all the things i love are solitary and slow which is not a surprise actually given i given, I suppose, what I do, right? Yeah. So reading, gardening and long walks, especially in crowded places. You like walking in crowded places. Yeah. So I'll go just walking. I mean, only if I have nowhere to go or be, right? So, I mean, you know, if I had somewhere to be and I'm in a crowd, it's like, get out of my way. Why are you walking slowly?

I think we're all like that. No, no, no. I will go when I need to recharge. I might walk from here to Canary Wharf, all the way along the canal. Or I'll go to a garden centre and just spend a day touching all the flowers and smelling things.

I've got my roof terrace here. It's looking a bit sad because I wasn't here this spring, but usually I have a beautiful garden and reading. So what are you reading at the moment i've just finished a book and i like to give myself a little bit of pause in between books yeah so the last two books i read were the invisible life of addy larue which is about this woman who's immortal she sold her soul to the devil it's quite good actually and the one

before that was hearts the hearts invisible furies beautiful book as well that was really good think i had a tear in my eye at the end i just like reading he's got lots of books i've only just moved to having a kindle john le carre i don't see ramble book by adam buxton i should have brought your copy i am a dick i was gonna bring you one oh i would have loved it i'll send it to you because i was gonna bring you a copy. You should have brought me. I am a dick. I was going to bring you one. Oh, I would have loved it. I'll send it to you because I was going to bring you a mug as well. Oh, that's so cool. I have so many signed copies up there. The John le Carré is because he's actually, and his family have been, huge fans of MSF.

David Cornwell. Yeah. Right. Yeah, yeah. So he often does things and gives money. And one of his last book, I got a signed copy. Where is it now? There it is.

Yes, that one. So he signed that for me. Oh, good one. Yeah. Now, on a practical level, when it comes to MSF, what do you tell people as far as how they can help and how they can get involved? I think the main thing for me is about an attitude, really, or it boils down to being a good citizen in the sense that, for example, it does matter who you vote for. Policies are made by countries and they're made by politicians. Or if you agree that, you know, refugees welcome, then join the march, tweet about it, amplify all the messaging that we're putting out, you know, talk about it to your neighbours, challenge that person who's talking crap on the bus. All of these little things for me is about supporting MSF or supporting generally, well, generally our agenda. I mean,

what is our agenda? It's not really an agenda. It's about, it's about welcoming people for people, you know. Yes, because MSF is not overtly a political organization. Not at all. It's about centralizing, really centralizing the person, you know, who's suffering and supporting them through it. But whether that's in migration or in conflict or in detention centers or in epidemics, if you're vaguely political, it's about supporting all those messages. messages if you want to just give money just give money i think msf is quite good about sort of portraying where we work and how we work and giving you a sense of ownership over how that money is being spent and so forth because i think people want that now you don't want to just give money blindly you want to know where it's gone and what the impact was yeah and it's not being used to build swimming pools for the people that all of that sorts of stuff exactly so that's definitely something you can do but honestly for me as i said it's about just sort of you know there are so many things that we can all

do every day you know being nice to your neighbor or how are you going to be an ally for that person who's being racially abused right now on the high street that type of thing and if you at least step out your front door with the attitude that you might be a good ally in that sense or you know be welcoming or whatever whatever then at least that that will translate into everything else that you're doing for me that's enough because i mean for msf for me it's a vehicle it's a vehicle for me to want to what is it help me to do my part to leave this world better than i found it this is an advert for squarespace every time i visit your website i see success yes success the way that you look at the world makes the world want to say yes it

looks very professional I love browsing your videos and pics and I don't want to stop and I'd like to access your members area and spend in your shop. These are the kinds of comments people will say about your website if you build it with Squarespace. Just visit squarespace.com slash Buxton for a free trial. And when you're ready to launch, because you will want to launch, use the offer code BUCKSTONE to save 10% off your first purchase of a website or domain. So put the smile of success

on your face with Squarespace. Squarespace. Yes. Continue. that you can find a link in the description of today's podcast, which will take you to MSF's website, where you can find out more about what they do. And if you are able to and so moved, you can make a donation. It will be hugely appreciated by Javid, MSF, and of course, the people that they help. As well as that MSF link, I've put a link to Javid, MSF, and of course the people that they help.

As well as that MSF link, I've put a link to Javid's Instagram page. In particular, the picture that he took of the sexy Jesus card that the clown man gave him. So you can see exactly what he was looking at. There's a link to a video of Javid talking about his work with MSF in South Sudan, The Flying Doctor, that's from 2014. There's a link to that TED talk that he gave in 2015 about his experience working in Sierra Leone and treating patients with Ebola. There's also a link to that documentary about Fergal Keane living with PTSD that came out, was it last year? I think so, 2022. That's on the iPlayer. And that's pretty much it, link-wise. Hoping to put out another podcast in the next few days, probably a little bit sillier than today's podcast and if you are looking for stuff to lift your spirits and cheer you up i would personally recommend

david mitchell's new book unruly i'm listening to the audiobook now i'm not sponsored currently by david mitchell's unruly sponsored by other david mitchell related tv products at various times but um i am a fan and it's pretty funny it's about kings and queens of england but he doesn't waste an opportunity to go off on a lot of very entertaining tangents. Like he goes off on a good tangent about the James Bond film, No Time to Die. And even though I liked that film, I thought it was quite good and emotional when I saw it, but his take on it was very good. Made me laugh a lot. Anyway, recommend that. What else?

Finally got round to watching Into the Inferno, Werner Herzog's 2016 documentary about volcanoes. I'm reading his memoir at the moment. Every man for himself and God against all. It very good the volcano movie was great incredible volcano footage as you might imagine but also some beautiful memorable sequences with some of the indigenous people of Indonesia and amazing stuff with people in North Korea. And of course, there's the joy of just Berner's voiceover. It is hard to take your eyes off the fire

that burns deep under our feet. There's quite a lot of planes out here ruining my moonlit outro. OK, I'm going to head back. Thank you very much indeed to Seamus Murphy Mitchell for his production support and editing on this episode. Thanks to Becca Bryers for conversation editing. Thanks very much to Helen Green she does the artwork for the podcast thanks to everyone at ACAST for their continued support but thanks most

of all to you for coming back for listening right to the end of this episode for your support of MSF if you are able to support them in one way or another. I really appreciate it. Now, I'm gonna come towards you and I'm gonna give you a hug. Hey, good to see you. And until next time, blimey, it's another plane. We are in a major, there's like three planes, one after another. It's crazy coming out of Norwich Airport. Where are they all going? Whatever. Take care. I love you.

Bye! Like and subscribe Like and subscribe Like and subscribe Please like and subscribe Give me like a smile and a thumbs up Nice like a five for me, thumbs up Give me like a smile and a thumbs up Nice like a five for me, thumbs up Please like and subscribe Like and subscribe

Like and subscribe Like and subscribe Like and subscribe Give me like a smile and a thumbs up ស្រាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពីរាប់ពវានប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប់ប� Thank you.