MSF Spotlight: Ms Sabrina Das
Written By Maha Khan
One of the greatest expressions of a clinician’s empathy and commitment to medicine comes in the form of undertaking an assignment for Médecins Sans Frontiers (MSF). MSF is an international humanitarian organisation which delivers medical care in crisis areas. Today, insecurity and injustice hold dominion on the world stage. Providing care in the depths of an active conflict zone can leave an indelible mark on practitioners, altering the way they provide healthcare moving forward, no matter where they are in the world.
This message is driven home by Ms. Sabrina Das, a consultant obstetrician vth and gynaecologist currently serving on the board of trustees for MSF, who has done several assignments — most recently in 2021 in Yemen. Today, she is in New York undertaking the Harkness Fellowship in Healthcare Policy and Practice at the City University New York School of Public Health, delving into reproductive law in the post Roe v.Wade abortion landscape. She is studying harm reduction and access interventions for abortion seekers. The conversation around abortion in the post-US election climate ties in seamlessly to her current work as well as the lessons from her time working in conflict zones. I recently had the incredible privilege of her company, where we discussed reproductive justice, cultural competence and the importance of providing humanitarian medical care.
New York New York…
Opening the conversation, a natural question arose - why choose to study through the lens of women’s health in the United States? With 13 states proclaiming total bans on abortion and the recent re-election of Donald Trump, public opinion has become increasingly polarised on the subject, making it a particularly interesting choice. Additionally, the American model of a private healthcare system is something many argue should be translated over into the UK. When asked about this, Das highlighted that consumerist culture is rife throughout the world and particularly in the US, where “even healthcare is monetised”. “You’re not a patient, you’re a consumer of healthcare” says Das, discussing their “dependence on the legal structure to front their healthcare policy”.
The overturning of Roe v.Wade saw the Supreme Court put an end to the federal right to abortion across the country, with certain states enacting complete bans on abortion. Das’ focus on reproductive justice sparked her desire to apply for the Harkness Fellowship to understand and ultimately feedback strategies into the NHS about how to make abortion provision “not just available but acceptable”. She believes wholeheartedly that doctors must step up and actively try to reduce clinical and structural barriers as well as aid in the removal of societal stigma around abortion. She highlights the MSF policy that views abortion as a fundamental form of healthcare —“ultimately, if women don’t have access to it, women die”. “The story I’ve found since 2022 where Roe v. Wade fell, is a story of activism, of clinicians getting involved in advocacy work, really stepping up and not ignoring their role in shaping policy”. This very shaping of policy is what she is currently working towards being able to bring home across the pond and implement within the NHS.
The NHS has failed women
“There’s no appetite to talk about it,” Das states when asked about the differences between the discussion around abortion in the United States versus the United Kingdom. It is certainly true that most of the discourse around the subject comes out of the US and trickles through the British media, but according to Das, there is not nearly enough noise coming out of Britain. “How many people know that abortion is criminalised in the UK? We’ve seen 18 women in the past 12 months prosecuted in the UK for suspected procuring of illegal abortion…the highest number in our recent history”. With the laws surrounding abortion being archaic, the primary pieces of legislation being the 1861 Offence Against the Persons Act and the following 1967 Abortion Provisions Act, the Royal College of Obstetricians and Gynaecologists have been campaigning for the decriminalisation of abortion. She touches on the fact that the same barriers to abortion access in the NHS exist when accessing family planning, contraception, and maternity care in general. “I think the NHS has failed women in a lot of ways because they’re prioritising the ease of care from their structural point of view, not putting the patient in the centre”. Das alludes to the many structural barriers in place which make it difficult for women to access abortion, such as the requirement for two doctors to sign off and legitimise the reasons for abortion.
Serving the underserved
Das is on a mission: “I became a doctor because I wanted to serve the underserved,” she says when asked about the necessity of placing emphasis on access to healthcare for minority groups. Unfortunately, Britain is known for blowing up the headlines with articles such as “Black and Asian women are more likely to experience stillbirth or die during pregnancy” and “Black women are less likely to receive endometriosis diagnosis”. The institutional and structural inequalities that exist within our healthcare system are glaring and require clinicians who are willing to fight for change. “It’s not just about having the people available to help, it’s about learning the strategies that work and what doesn’t work”. Das cites an option which is becoming increasingly popular in the US - to study MD/MPH, a dual Medical Doctor and Master of Public Health degree, something that she firmly believes should be integrated globally.
Whilst medical students in the UK are trained to consider the social determinants of health and to think about how institutional policies can affect healthcare in inequitable ways, Das criticises the “five-week block in public health” that broadly sums up the depth of education medical students truly receive in these topics, which can have far-reaching consequences. Looking at her own educational background, Das’ experiences working with MSF and beyond have her hoping to pursue a Master of Public Health; “It’s something I should’ve done years ago to be honest, but you know, better late than never!”. Looking at abortion with this same sentiment, Das examines why abortion stigma still exists within the NHS. “How many of you (medical students) are going to witness an abortion on placement and realise it’s just a simple, routine bit of healthcare that can be done in a clinical setting, most of which without anaesthetic”. After just a short discussion, it’s apparent that medical education should be a primary focal point for where change is most urgently needed.
Cultural Competence
Das reflects on her time serving her local community while working at the Homerton Hospital, how that influenced her attitude towards cultural competence and how this translated across into her work for MSF. Learning about the beliefs of the Orthodox Jewish community gave her insights into multiparity and grand multiparity, as well as the risks of caesarean section in these cases. She says, “I took so many of those messages into the low income setting when I was working with MSF, because there’s all these other contexts where women, whether by choice, religion, culture, or just societal circumstance, don’t have access to contraception so have to have many pregnancies; I learned how to manage that”.
Taking her experiences from her local community and her experiences in Yemen, she has been able to look beyond societal prejudices in her work. “I think in the West we have a real negative impression or a lot of misunderstanding about what Islam means… when I was in Yemen I definitely received an education on how their faith really gave them the strength, comradery and structure for lots of healthy and positive behaviours”. Das attributes the ability of the Yemeni people to survive through a chronic war to these same values and behaviours. “The approach to loss and bereavement is much healthier than some of the approaches I see in England… death is a normal part of the human experience, which I don’t think we understand here”. She cites ‘blame culture’ and excessive litigation as just a few reasons as to why there is such a struggle to work in maternity in England at the moment. Furthermore, she praises the communities that form from shared faith and the willingness for people to help one another. “Adversity creates innovation, advocacy, community organising and a sense of togetherness”.
Ticking boxes
It’s easy to imagine a plethora of challenges that might arise when working in an active conflict zone, but it was surprising to find out the challenges that proved the greatest were similar to ones tackled at home day-to-day. “I think what I didn’t expect was the amount of conflict I had with the other international staff… you can be a little vulnerable to team dynamics and social strains”. Das recalls that she was in Yemen in the midst of the COVID-19 pandemic, which she said exacerbated the usual workplace troubles. “Despite the fact that a lot of it is very unique, a lot of challenges are the same as you’d have in any hospital like hierarchy, interpersonal relationships and team-working, all of which make or break a team experience, just all within a low resource setting”. She also recalls the difficulty of language barriers and reliance on translators to communicate effectively with the women she was treating. Yemeni law requires the male relative of the woman to give consent for any medical procedure, the antithesis of what Das believes in. However, she recounts her attitude as “treating it as a box to tick, we have so much unnecessary bureaucratic paperwork to do in the NHS, so for me that was just another piece of paperwork, where I was really trying to focus my energy on the conversation I was having with the woman”. It is without a doubt that working for MSF can be arduous, but the effects on the local communities can be profound.
Looking at the global tapestry of healthcare delivery, there is certainly no ‘one size fits all’, but there is undoubtedly a need for bold reform and innovation in the NHS. With a developing insight into the broader landscape of healthcare delivery, whether that be through prestigious fellowships in New York or humanitarian aid work in Yemen, Das gave an insightful and uniquely informed perspective on the changes needed regarding abortion care in Britain.
Read the rest of the edition here
