Life education on the front line

Cate Swannell
Med J Aust
Published online: 1 September 2014

Dr Alan Hughes spends his semiretirement in some of the world’s most underresourced health hotspots, delivering babies, repairing fistulas and saving the lives of women giving birth in the most difficult of conditions.

Alan Hughes sometimes finds himself wondering if most Australians have any idea how lucky they are when it comes to health care and health resources.

Just back from his sixth mission with Médecins Sans Frontières (MSF), Dr Hughes says his experiences in Africa and Pakistan have been life-changing.

“It’s changed me, certainly”, he tells the MJA.

“When you come back you do notice the change. I’m not quite as sympathetic when people whinge about small things as I used to be.

“It’s like living in two parallel universes. Here in Australia, people don’t realise how very lucky they are.”

Dr Hughes is an obstetrician and gynaecologist who has worked with MSF in Nigeria, the Democratic Republic of the Congo, Pakistan and South Sudan.

He is Canadian by birth and graduated from the University of British Columbia in Vancouver before travelling with some classmates to do his internship in New Zealand in 1974.

“They were very doctor-depleted in New Zealand at the time, and there was just the one medical school, in Dunedin, so there were young doctors coming in from all over the world. It was like a little United Nations.”

After 2.5 years, Dr Hughes “crossed the ditch” to work as a general practitioner in Toowoomba in south-east Queensland and after another couple of years he moved on to Tennant Creek in the Northern Territory.

“Tennant Creek was great — much more exciting and challenging”, he says, of the 2 years he spent as medical superintendent covering the entire Barkly area.

“We did get some support from Alice Springs, but most of the major clinical scenarios that came our way were in obstetrics”, Dr Hughes says.

“At that time I had only done introductory obstetrics, and I was uncomfortable with doing caesarean sections.”

He made the decision to further his obstetrics training by studying in the United Kingdom in 1981. He planned on being there a year but, as things often happen in life, he “got caught up”.

“I met my wife there — or rather, met her again — we had met once in Tennant Creek earlier”, Dr Hughes says.

“After 7 or 8 years working in obstetrics in the UK, Chris and I talked about going back to Australia. A surgeon I’d known from Tennant Creek said there was a position available in Alice Springs, so we had a look at, decided we liked it, so we came back and the rest is history.”

“History” is 20 years of running the only private obstetrics service in Alice Springs with Chris, a midwife, at his side.

“It’s not unusual for young people to come up to me in restaurants and tell me that I delivered them”, he says.

In 2009 the Hughes decided to relax into semiretirement before selling up their practice last year and moving to Adelaide to be closer to their two grown daughters and their families.

It was in semiretirement that the lure of volunteering with MSF began to appeal to Dr Hughes.

“I saw it as a brilliant opportunity”, he says. “I always knew MSF needed trauma specialists and surgeons and anaesthetists, but I had no idea until then that they needed obstetricians as well.

“MSF explained to me that because of the UN’s Millennium Development Goals, they were focused on maternal mortality. There are heaps of places in the world where the rates of maternal mortality are horrendous — where timely blood transfusions and C-sections are hard to come by.”

Dr Hughes’s first mission, in 2010, was to a community called Aweil (Uwayl) in what is now South Sudan.

“It was the most undeveloped, least infrastructured place I’ve ever been to”, he says. “It has a horrendous history — wars continuously for the past 40 to 50 years. There’s been no time to build an education system or a health system.

“There were no sealed roads, no running water and the only electricity came from the generator.”

MSF, Dr Hughes says, are expert logisticians however, building elevated water tanks which generated enough hydrostatic to reliably service the operating theatre.

Because transportation was so problematic, women were often in labour for 3 or 4 days before being able to reach Dr Hughes’s hospital in Aweil.

“By the time they got to us, often their babies were dead”, he says. “It was very challenging because we were dealing with situations that you don’t see very often here at all. A lot of the principles are the same but because of the lack of resources you learned a huge amount on the job.”

Dr Hughes says he never felt scared for his own safety, again thanks to MSF’s experience and procedures in such situations, but with women bleeding to death with only his skill and determination to help them he certainly felt “confronted”.

“It becomes a little bit addictive, if I’m honest”, he tells the MJA.

“When you’re constantly challenging yourself like that, it’s like starting a whole new career, putting pressure on yourself all the time.

“You have to really want to be there.”

After 8 weeks — “to be honest I could have stayed a lot longer” — Dr Hughes returned to Australia, but had no hesitation signing up for another mission with MSF.

This time it was to the north of Nigeria, in a region called Jigawa, on a dual mission to not only tackle maternal mortality by reducing uterine ruptures, but also establish an obstetric fistula repair service to repair and prevent fistulas.

“The most satisfying part of that is that I’ve been able to go back three times at 2-yearly intervals and it’s been possible to see how far things have progressed there”, says Dr Hughes.

Peshawar in Pakistan was his next MSF-directed destination, where Dr Hughes worked to maintain links with rural networks and provide access for women to a tertiary hospital.

“I’d been through Peshawar when I was a student, when it was a beautiful city”, he says. “But going back to it, it had changed so much, been damaged so much by war, and there were a huge number of refugees.”

Wearing local dress and respecting local customs are all part of the job on an MSF mission, and it is the people who have taught Dr Hughes the most on his various trips.

“The way people handle overwhelming misery and grief has been a real eye-opener for me”, he says.

“For example, in Sudan, a colleague of mine who was involved in recruiting teachers told me that in one class of 50 only one child still had both parents alive. Everyone else’s had been killed in the wars.

“People [in that situation] don’t dwell on the past because it’s so awful. And they don’t think about the future because it is usually so uncertain. They tend to live very much in the present. They’re happy and dancing and singing all the time.

“It’s been an education.”

The Congo posting was, Dr Hughes says, his favourite, so much so that he will be returning for another mission at the start of November.

“This area has been very unstable right up until the UN moved in earlier this year”, he says.

“The people have been through the wringer there more than anywhere and yet they are always laughing and dancing. They have a large Catholic church and a mass is held every Sunday just for the children.

“I’m not a church man, but a colleague invited me along and it was just inspiring. It was all in Swahili but the music was familiar and I always left those services feeling good.”

Dr Hughes would recommend the MSF experience to any doctor, though he admits it is hard to find the time.

“For a lot of doctors in the middle of their careers it can be very difficult to get away. Unless you’re doing locums or are semiretired it is difficult to find the time.

“Even if you only do it once and decide it’s not for you, you’ll never ever regret it and you’ll come back enlightened. It’s a life education.”

For information about working with MSF, visit their website at

  • Cate Swannell



remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.