Courtney Bercan

Nurse for Doctors Without Borders

Courtney Bercan helps people affected by life-threatening epidemics, injuries and disease, regardless of race, religion or politics, as a nurse with Doctors Without Borders. Working in remote rural Northern B.C. communities gives her high-level diagnostic and assessment skills that are useful abroad, but nothing could have quite prepared her for plucking people from the Mediterranean sea on a refugee rescue mission. It’s literally a sink or swim scenario, and in an emergency there isn’t always time to reflect or digest, so she has turned to blogging about her experiences – the lives she’s saved and lost and the devastation she’s witnessed – as an outlet. Though she prefers hands-on action and celebrating the little things to personally actioning broader policy reform, she’s joined her voice to the many speaking out about injustices in all corners of the word, as her experiences have reformed her ideas about privilege in a global society.

You are the biggest constant in your life - period.

What other people think matters up to a point, but having a realistic, balanced, and kind self-concept is what allows me to actually grow from conflict, insecurity, or criticism instead of letting it overwhelm me…or at least that’s what I’m working on…

When everyone at home is having babies and you’re on the back of a motorcycle driving through a conflict zone, it makes you think…

I realized early on that my life wasn’t going to take a totally conventional path (and that it was ok) and it released me from feeling a lot of pressure to do so.

Most times in life things don’t go the way I expect; Some of the best moments and decisions of my life have come about in an effort to find something positive in experiences of disappointment or loss.

On a practical level, you may find “cleaning toilets” to be a part of your humanitarian job description – being flexible is the only way to be successful.

Since I live out of suitcases and my life is frequently influx, it’s important to find small rituals and comforts that give me a feeling of familiarity and control

Regardless of whether I’m in an airport, a compound in the Congo, or crashing on my parents couch (for the millionth time).

As a nurse, I am constantly confronted with the fragility of life.

While I definitely need my alone time, connecting with people and cherishing my relationships are the most important things to me.

Even though in a lot of ways I have my dream job and life at the moment- it doesn’t mean all your problems just go away.

Life is still damn hard sometimes. I try to find contentment and victories in the small things because they help me stay resilient when times get tough.

“The Veil of Ignorance” is a concept by philosopher John Rawls that I use as a motivator, and sort of, moral compass.

How would I want people to act and what kind society would I want to live in if I didn’t know my place (social status, race, gender, abilities, etc) in it.

I love beautiful places, the outdoors, travel, and adventure.

When I found something that filled me with so much joy and passion, I let it guide my life and choices.

Laughter, exercise, and baked goods! Endorphins have got to come from somewhere and it can’t always be cookies!

There is a direct link between how much of these things I have in my life and how sane I feel.

The colleagues and patients I have met along the way make me feel incredibly lucky I get to do this job.

My colleagues are so often the types of practitioners that I aspire to be and I am learning constantly from my patients’ stories and strength.

You started nursing about five years ago with the goal of working for Doctors Without Borders, which is commonly known as Médecins Sans Frontières or MSF - what was the draw?

When I first discovered they existed, I was about 19 and had just come home from my first year abroad; I think you’re kind of realizing what you really value at that time, and kind of coming to a realization of the inequities in the world. I felt like I wanted to contribute; to at least make the world a bit of a better place, especially when I read about Doctors Without Borders’ mandate – to work in places where people wouldn’t otherwise have healthcare because they’re remote or they’re in conflict zones. Realizing what people don’t have access to because there just so happens to be a civil war – or a huge hurricane or flood – kind of blew my mind, and so the organization really attracted me. I really liked their neutrality, impartiality and independence; no decisions on triaging and providing medical attention for someone are based on their politics or place in the world, it’s based solely on need.

Did you always have your heart set on becoming a nurse?

No – I always swore that I’d never become a nurse. I used to think it was one of those typical feminine careers – you either become a nurse or a teacher – and that’s what a lot of people around me were wanting to do and I just didn’t get it. I was sort of like, why? I think I had the antiquated idea that nurses were just these sort of doctors’ assistants, but then some friends went into nursing and I was hearing about the incredible things they do, and the amount of responsibility they have, and the skillset and practice really interested me a lot more.

You transitioned from urban to rural nursing; can you speak about that? Do you feel the work prepared you for MSF?

It’s a hard transition; you’re going from working in a place where you have a ton of support to places that your resources, basically your supplies and your clinic, everything is a lot more limited. You’re taking on a lot more responsibility and a more autonomous role.
I don’t think I realized how big the disparity was within my own country in terms of health outcomes for Canadians and First Nations and indigenous populations; it’s definitely become a lot clearer working in these communities.
I don’t know if anyone would ever feel 100% prepared for MSF because there’s so much to learn within the organization itself, but every single day I was on assignment with them, I was very grateful for my experience up north.

I understand you’ve completed two missions with Doctors Without Borders: working at a hospital in the Democratic Republic of Congo, and being part of a nautical search and rescue crew picking up refugees and migrants out of the Mediterranean Sea. What are some of the field work moments that stand out to you?

Oh my goodness, there are so many! In the Congo I was dealing a lot with my first really sick pediatric patients; kids come into emergency and they’re on the verge of death – you don’t see that often here. If it’s something that you’re able to treat relatively well, say malaria or malnutrition, then you get to see these kids go from near-death to jumping and playing and smiling and just being normal kids – that’s a pretty incredible experience.
Being on the ship, Dignity One, was really tough emotionally. The experiences that stick out to me the most are actually really sad. Things like trying to resuscitate someone’s wife right in front of them and not being able to, or having to take parents to identify their children’s fuel-burn-covered bodies. But on a more positive note, we were really committed to taking the time to treat people like human beings, with dignity; it was often something they hadn’t had in their home countries or during their journeys as they tried to reach Europe.

How do you cope with the emotional distress?

It’s really hard; it’s something I’m still trying to learn how to deal with. Often in the moment, I can’t – I just do my job. I have some moments where I cry with my patient, and hug them, take off the nursing hat for a moment and be human with them; that definitely helps.The biggest thing I do is set a pretty low bar for celebration. There’s so much tough stuff we’re all dealing with that if I have been able to connect with a patient, if I’ve gotten that hug, if it’s a little kid thanking me, I celebrate those things. It’s really those things that you have to hold onto, because sometimes you don’t get the big wins, and the big wins that you do get are usually pretty slow in coming.

You were blogging from the ship - did telling the story also help?

I knew I’d done everything physically possible while I was with the patients and it still didn’t feel like enough. Putting something out into the world that might help people at home understand what so many of these people are up against felt like something else I could do.

Were you up against other elements beyond dealing with critical patients?

I was seasick for two months; missions always have physical challenges. The boat was pretty amazing because we had fruit, vegetables, a variety of food, and also air conditioning. I’m not sure if there’s another MSF mission in history that’s ever had air con, but I was pretty damn thankful for it. The living conditions can be quite challenging: bucket showers, sharing rooms for months on end, restricted access to healthy food; isolation, lack of internet; I could go on.
That said, I think being Canadian and growing up camping means it doesn’t always bother me to live in more challenging or basic conditions. You just have to get into a groove, and let the little things that remind you of home give you a feeling of stability.

What are some of your must-pack items or downtime rituals when working abroad?

Trying to stay in contact with friends and family at home on a regular basis helps a lot. Having your favourite food,t-shirts or podcasts – just things that make you feel comfortable, things that make you feel like you’re in your own skin no matter where you are.
I bring my two favourite shirts but I almost never wear them on missions because I’m paranoid about losing them in the laundry or destroying them. Just having them comforts me, and I can wear a nicer outfit if there’s a feast or get-together and I don’t want to show up looking like a gross humanitarian bum in a stained torn up t-shirt.
I stock my iPod or phone with my favourite podcasts, like Everyday Emergency, which is a Doctors Without Borders podcast that I love – but it can be a bit intense to listen to on a mission. I also really love Serial. I’ve watched seasons 1 & 2 of Broad City probably three times. You just sometimes need something that makes you laugh.

How has your career and lifestyle changed your perspective?

I think the biggest thing is it really humbles you. I’ve always been a person who kind of fights for the underdog, and I’d always considered myself fairly compassionate and sensitive to people’s struggles but I think this work has put those feelings on overdrive. Seeing people around the world in dire situations and knowing you could be in their shoes except for the luck of having been born where you were, it’s pretty humbling. I think sometimes we think we really earned where we are in society and really worked for it, and while there’s nothing wrong with pride in your accomplishments, there is a bit of a lack of understanding about the huge head start we were given in life by being born in Canada. I was born into a family – we weren’t perfect, we didn’t have a lot of money – but they made sure I knew I was loved; I had support, and that’s a pretty massive privilege.

Upon returning home from a mission, how do you turn rescue mode off?

It’s really hard, and I think each assignment kind of affects you a bit differently, but typically what I find is the first two weeks is a kind of honeymoon period. I just settle into things and enjoy all the little luxuries, and then it kind of hits me: the disparities, you know, what people are complaining about, what you find yourself complaining about. Coming home can for sure be an emotional adjustment, but I have supportive family and friends who listen to my stories and cry with me and that definitely helps.

When you do have down time, where do you go?

Well, I travel a lot ; I think I’ve been to over 60 countries. I especially loved Iceland, South Africa, Myanmar, and Jordan. For real down time I usually just kind of camp out at one of my parent’s houses and see friends and family and enjoy that.
My life is always a bit in flux; I’m here in Hazelton for another couple weeks, and then I go to Bella Bella for five weeks, and then from there I’m not sure yet.

Industry-wise, does Doctors Without Borders pay well or is it more about passion?

I would say it’s passion driven over finance driven; it pays, not particularly well, but it’s enough for most people to cover their expenses back home while they’re gone. Doctors Without Borders is an organization that supports you in education and career development though, and your pay goes up as your experience and responsibilities increase.

Some might see your career as a personal sacrifice; you must miss moments with family and friends while you’re away saving lives. Is there some truth to that?

I think you’re always going to be making some sacrifices, regardless of what you want to do. For example, if you have kids, you’ll be deciding whether to stay home with them or work full-time; every job comes with something you’ll be giving up.
In my case, I don’t think that it’s necessarily a sacrifice but an alternative lifestyle choice. A lot of the time I think about my life and I just feel so, so, so lucky that I get to do what I’m doing. I honestly love it. The incredible professional and personal moments that I experience and the colleagues that I get to work with are for me the coolest things in the world, despite it being damn hard.

It’s obviously hard work; is part of the payoff witnessing improvements in how healthcare is provided abroad?

You know, both my missions have been classified as emergency missions on the shorter scale of things, so it’s hard to see long-term change. The ship mission was also very atypical because we were just out there plucking people out of the sea – the danger was immediate. MSF picked up 19,000 people last year and those are people that may not have survived otherwise; you can hope that someone else would’ve picked them up, but we happened upon boats that were in the process of capsizing, so that’s definitely not a given.
In the hospital however, there was a lot more trying to teach and improve practice for the local nurses and doctors; we helped them with equipment and supplies and medications that they wouldn’t otherwise have.

Does doing this type of work inspire you to climb the ladder until you’re in a position to reform policies?

I went into nursing because I really did want to be able to provide hands-on skill, versus being the one to personally make the policy changes. I know that that’s super important, and it goes hand-in-hand with what I do, but I’m actually pretty happy that I’m not one of the people doing that. I’m fortunate to work for an international organization leading the way with phenomenal people working those angles.
That said, I’ve done a lot of press regarding this since my blog. Sometimes on the ship I was experiencing hell, like actual hell, and it felt like no one was listening or cared, and then I’d read heartless comments on articles about the migration issue and it felt like many of us trying to help were just screaming into the wind. For me, to be able to speak out a bit more publicly on these issues has been pretty cool, because I feel like I’m actually able to help people understand some of what’s going on around the world, which can in its own way help lead to policy change.