Good Medicine
Mary Jo Frawley of Doctors Without Borders may live in Sunset Beach, but her head and heart are in Sri Lanka, Somalia, Mexico, Angola . . .
Several weeks ago, a colleague of nurse Mary Jo Frawley handed her a short New York Times news story that read like an afterthought: “A woman was stoned to death on Monday in an Islamist-controlled region of Somalia,” read the three-sentence brief. The young woman had said she’d been raped and was promptly charged with adultery by the religious extremists in control of the region, and then killed. For Frawley, the information was dizzying. “I was just there,” she thought to herself. “How could that be?”
Frawley, 53, is a kind of collector of lessons, paying close attention whenever and however she can to what someone in front of her or some new experience may be teaching her. “We were there to take care of them—to take in those women who had been raped,” she says about the six months she spent working as a nurse near a string of Somali refugee camps late last year and early this year for Médecins Sans Frontières (Doctors Without Borders), the 1999 Nobel Peace Prize-winning international medical humanitarian organization she has been active with for nearly a decade.
She knew the women were taking big risks to see the medical teams, but she hadn’t realized they were endangering their lives—including violent retaliation from the radical militias. “The fact that women were coming in to see us and the fact that people knew what was going on was a big risk. The confidentiality was so big, and I had no idea how big it was until I see this in the paper the other day, of what these women were risking, to come in and say, ‘Mary Jo, this happened to me, and really, I’m not a bad person.’”
When you meet her, Frawley might shake your hand and not let it go for a few minutes; she might suddenly remember her time in Sri Lanka and how much she liked that people there spoke to one another without letting go. Or she might show you how in Nigeria, you greet by lightly padding shoulder to shoulder; elders get more pads. “I’d get nine of those,” she says, laughing. “That tells you how old I am.” Frawley has the ability to extract something curious from the most mundane of activities—like shaking hands—and blend it with some other faraway moment in which something was learned or shared. In these brief instances, she brings together her often disparate realities—many months spent in war- and disaster-torn corners of the world; short weeks during the year with friends and family in northern Vermont, Tucson or her “permanent” home in Sunset Beach—and makes them seem part of one cohesive experience.
On a hazy, pink, October afternoon in Santa Monica, where Doctors Without Borders (DWB) has propped up a simulated refugee camp against the city’s historic pier—the latest stop on a national tour meant to give latte-sipping beachcombers a glimpse into the organization’s hardscrabble work environment—Frawley walks buoyantly through a knot of tents depicting vaccination and child-nutrition stations, water-sanitation posts, latrines, and cholera-isolation areas. She has traveled to more than 45 countries, completing 16 missions.
Missions last anywhere from a few weeks to more than a year; Frawley has spent 75 months in the field. (Only about 10 percent of the organization’s 24,000 staffers work internationally, like Frawley; about 200 of those are American.) “Sixteen is really at the top end of the number of missions people do,” says Nick Lawson, director of Field Human Resources, of Frawley’s time with DWB. “She’s pretty adaptable to just about everything we do these days. She’s been in some very tight situations, that’s for sure.”
Lawson isn’t exaggerating. Although violent incidents are rare, DWB aid workers have been kidnapped, held hostage and murdered. Some have even become deathly ill from infectious diseases.
Frawley stares out at the Pacific Ocean as it rolls reliably onto the shore. She’s been back in the U.S. for three months—longer than usual—to oversee the touring camp and to visit with her mom, old friends and family. She gets up every day at dawn and runs about 8 miles before going for a swim in the ocean. She knows she’ll be traveling again soon, most likely to Haiti. “I’m just trying to get a sense for whether I’m the right match for what they need right now,” she says.
What she doesn’t say is that she has often been considered the right match for the extreme conditions DWB deploys its aid workers into because, as one of Frawley’s former mission directors, Rebecca Golden, puts it, “Mary Jo is unrelentingly calm.”
Frawley is small and lithe, tipping onto her toes and leaning in close when she talks. She gets even closer when she whispers (which is often), and then pulls back and grabs your arm when she breaks out laughing (also often). Her emotional range takes on parabolic dimensions, revealing a natural gift for the kind of storytelling that might entice a crowd of kids. She’s perennially at-home with and fascinated by children. “Kids are the ones who teach us. They’re the ones who know,” she says.
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Before joining DWB full-time, Frawley worked in Long Beach Memorial Medical Center’s ER and pediatric-intensive-care units for 16 years. She was also a pediatric-home-care nurse and often brings up Eddie Lopez, a cancer-ridden boy she took care of during four of his six years of life. “He was incredibly calm,” she says. “He wasn’t afraid of dying.”
One evening in the ER in the mid-1990s, a colleague told her he was going down to Guatemala with HELPS International, a Texas-based aid organization. “I hadn’t heard of Doctors Without Borders then,” she says. At that point, she had never been out of the country. She joined her colleague and made her first international aid trip, helping to establish surgical units in remote parts of the Central American country. “That was it,” she says. “It lit my fire. I kept going, using up all of my vacation, sometimes going for a month at a time.”
She eventually learned about DWB from a friend, but she wasn’t familiar with the organization’s protocols. When Hurricane Mitch ripped across the coast of Guatemala in 1998, Frawley put a call in to DWB and told them she had found people to cover her RN shifts and could leave at any moment. The woman on the other end of the phone politely told Frawley to please fill out an application and wait to hear back from administrative staff.
“I was like, ‘Forget you!’” she says. “It was my own naivete.” But within two days, she stocked up on donated water from Trader Joe’s, pharmaceuticals and plastic tarps and purchased her own ticket to Guatemala. “I had a contact there who I’d found,” she explains. She went down on her own for a couple of weeks and worked at a clinic, but when she returned, she decided to approach DWB more methodically and was soon called in for an interview in New York City.
“These were the stepping stones,” she says. “I think it’s critical that people do stuff like that, you know? A lot of people run up and say, ‘I can do it!’—but have they done the footwork? What’s it take to leave your family, your friends?”
Her first six-month mission was to Sri Lanka in 1999. It was a bit much to get time off, so she quit Long Beach Memorial. Then, once in Sri Lanka, she extended her post to nine months.
Frawley weaves vigorously between stories about tracking down children for measles vaccines in the remote Himalayan villages of Tajikistan, treating 400 child soldiers during their disarmament in Sierra Leone, and propping a bed up under a mango tree for a man who was suffering from the deadly and highly contagious Marburg virus in Angola. “He wouldn’t stay in the ward. He was in a lot of pain because this starts out as joint pain, then fevers and bleeding,” she says. “So I said, ‘Okay, we’re gonna make it special for you.’ The team set him up under the tree with a little radio. It was the Marburg Morphine Mango Tree! We’ve got a great picture of him waving. And he survived.”
With DWB medical teams, Frawley has worked among Ebola, Marburg, malaria and cholera outbreaks; trained local nurses, midwives and community health workers; set up feeding centers for malnourished kids; carried out measles-vaccination programs; and worked in surgical, maternity and pediatric wards. She survived a bad bout with a particularly lethal strain of malaria (“I highly recommend, as a learning experience, that you take the malaria prophylaxis if they tell you to”). But she’s especially pleased with the outcome of the Marburg experience. The virus can cause people to bleed to death from multiple orifices within hours of contact and is often treated like HIV was in the early days, says Frawley. Medical teams who treat Marburg must wear full protective gear akin to Dustin Hoffman’s super-suit in the film Outbreak. “It’s a virus that attacks everything,” Frawley says.
“But I was with a team that said, ‘You know, we trust our outfits, we trust each other, we trust the protection mechanisms that we’re using, but we’re gonna do it differently.’ We went in, and with the national staff, we taught them how to do nursing care,” she says. For the first time, patients were washed, touched and given IVs, fluids and medications instead of being quarantined to die. “We had great success. Some of them walked out. Perhaps the strain was not as strong toward the end of the epidemic, maybe it was a bit of a flap, but we changed protocols for how you treat patients,” which in the end, Frawley says, was important.
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“She was very willing,” says former mission director Golden of Frawley’s desire to go into the most remote and often more challenging situations. “She was always the one who wanted to be really close to the people who were suffering.”
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Beyond the massive Moreton Bay Fig tree in front of San Diego’s Natural History Museum one recent evening, a crowd has gathered just after sunset to hear what these border-hopping doctors and nurses have to say about their adventures. Frawley cradles a necklace given to her by her goddaughter. She keeps this necklace—along with ones from her sister and from nurses in Sri Lanka, a bracelet from her parents, another from the Masai tribe in Kenya, as well as a few others—on all the time, even when running and swimming. “That way, they’re always with me,” she says.
“I’ve never done this before,” Frawley says before the discussion begins. “We’ll see.” Her outfit, a thin, gray, hooded sweater over a deep-turquoise blouse with a plunging V-neck is something a friend put together for her, she admits.
Before her interview with DWB in New York years ago, Frawley trotted down to the consignment shop and bought herself a bright-red Ann Taylor suit. She’d never worn anything quite like it. Usually, she sports a slight variation of the same thing: loose, ankle-length pants, a T-shirt, and either a hoodie or a fleece zip-up.
She was staying in some “two-bit” hostel in New York. She was nervous, not so much because she doubted herself, but more because she didn’t feel like herself in the suit. “When I walked in, they just gave me a look,” she says, laughing. “Thankfully, bless them, they’ve never told me what they thought of me in that first moment.”
The San Diego panel is moderated by a perky local radio reporter with a British accent named Alison St. John, whose credibility with the impressive lineup (all of whom sit with varying degrees of the same faraway look in their eyes) rests on a brief jaunt she had with the British equivalent of the Peace Corps. “I soon realized it wasn’t for me,” she says. St. John, who is probably not much older than Frawley, rattles off the list of some of the countries Frawley has worked in: Tajikistan, Somalia, the Democratic Republic of Congo, Liberia, Sri Lanka, Mexico, Uganda, Sierra Leone, Nigeria and Angola. “You’re very well-traveled!” she says cheerily.
Frawley whispers into the microphone at first. She’s uncomfortable with all the attention. St. John tells her to speak up, and Frawley pulls it in closer. She brings up Eddie Perez and the lessons, and St. John encourages her to move on to the international stuff.
Later in the evening, a man in the back stands up and asks what he refers to as an “ethical question.” “We’re living in an overpopulated world,” he says. “You’re working to keep people alive in these very, very poor countries when there really are not enough resources to meet the needs of the healthy populations.” So, he wants to know, wouldn’t those resources be better spent on healthy people, since the world is already overcrowded anyway?
A cool murmur swims through the crowd. The panelists squint up into the corner, trying to catch a glimpse, perhaps, of the man who asked the question that so completely misreads the nature of the organization’s work, which is founded on the premise that everyone—no matter their nationality, income level or political affiliation—deserves to live. They look at one another, trying to mask disbelief.
“That’s a really excellent question!” St. John says. “Did everyone hear that?”
The panelists whisper quickly to one another and decide that surgeon Sandra Freiwald will respond. “All of us here will be able to tell you that on a one-on-one, healing-to-healing basis, when you see someone who you have the ability to help, it’s impossible for me to walk away from that.” The audience applauds.
As the evening progresses, it becomes evident that none of the panelists harbors illusions of save-the-day heroism. They talk about sobering experiences in the field, of having both the blessing and the curse of being able to make medical and logistical decisions they would never be able to make in their own countries.
Frawley tries to explain why she keeps going back—and, whether or not she intended to, also addresses the “ethical” question asked earlier in the evening. She recounts a trip this past summer to Nigeria, where she was looking for and treating malnourished children. Often, she and her team members were invited inside villagers’ homes during the nutritional assessments for tea, despite what might be going on around them. And often, Frawley and her team members would stop and trade stories.
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“That’s the kind of atmosphere I’m attempting to prolong, just to sit and listen,” she tells the group. “Just sit and be a part of it. Don’t be that type-A, hyper, ER nurse, which you know you can be. Just go ahead and spend time. That’s why I initially signed up with Doctors Without Borders—because I wanted to spend more time. I wanted to learn what it was like to be there. I wanted to be able to enjoy that cup of tea.”
People are people, Frawley often says, and whether she’s back home or in a remote village in Nigeria, it matters that everyone in the room take one another for who they are, that a real exchange occur, if for no other reason than to recognize their shared humanity.
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Back in Santa Monica at the refugee-camp exhibit, Frawley points to a large photograph of a real Somali camp and the endless rows of cardboard igloos held together by flannel shirts, sarongs, blankets, newspapers and wire. She looks hard, not at the photograph, but into it. Her face crumples a little.
It took DWB two years to get into Somalia. Once there, in late 2007, the team assembled a hospital in a bombed-out Italian building, but it was condemned soon after. They found another location and began to rebuild surgical and maternity units. “We had just finished renovating this nice area for the maternity ward,” she says, trailing off. She stares harder into the picture, kicks her running shoe into the ground and clears her throat. “Yeah, wow . . . we were just gonna start with the ward, and everybody was ready for it. Huh. And then. Then came that moment in time.”
On Jan. 28, just after lunch, a vehicle carrying two of Frawley’s colleagues in Mogadishu exploded in front of the car she was riding in. A roadside bomb was detonated as the vehicle drove past, killing Frawley’s French, Kenyan and Somali colleagues. A prominent Somali journalist walking down the street near the car was also killed. “‘It was targeted.’ ‘They killed us.’ ‘They were looking for someone,’” she says. “There were a lot of theories. We’ll never know.”
Those remaining, including the fiance of one of the victims, were evacuated hours after the explosion. “The organization was remarkable,” she says. “They got us out quickly and allowed us to attend all of the funerals. They brought in mental-health specialists and just let us talk and talk. I was lucky that I have some incredible friends who allowed me to talk about it. I needed to. We were all in shock.”
But she wasn’t home for long. “I needed to go back out, so I took a mission in Nigeria where I would be working with children again. We would be visiting homes and be outdoors,” she says. “I needed to do it. It was what helped me heal.”
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Frawley appears in an episode of Doctors Without Borders: Life in the Field, a 2003 National Geographic TV series. She’s sitting in a jeep in war-torn Sierra Leone, traveling along crumbling red-clay roads to visit patients in village clinics. She sees someone on the road and blows kisses. “Stop, stop, stop!” she says to the driver. Someone hands her a pineapple from the road, and she gets out. “How’s the pikni? How’s the pikni?” Frawley asks, smiling at the mom and the baby she helped to deliver. She tells the baby’s mother to keep him warm because the rainy season is coming, and then she hangs out the window waving as they drive off.
Frawley never had any children of her own—she never married, and menopause hit surprisingly early. But she’s found the lesson there, too: “I’m coming to a level of acceptance that I will probably never have any children of my own,” she says in the segment, “but there are plenty to bring into my life.”
Near the end of the segment, Frawley stares out of her car window in Sierra Leone, closes her eyes and lets the wind wash over her. “This is the best job I’ve ever had,” she says. She and her colleague John Komora, a nurse from Sierra Leone, have treated a newborn baby, his ailing mother and a severely malnourished 3-year-old. The experiences chronicled in the segment represent only a fraction of an endless string of stories.
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“Each experience has really been so full and its own complete thing,” says Frawley, reflecting on her work while back home in Sunset Beach. Re-adapting to life in the U.S. after every mission has become easier over the years, she says. “After my first mission in Sri Lanka, I came back with ‘the Look.’ I’d be in a conversation with some friends, and my eyes would drift above their heads, and I’d keep hearing in my head, ‘Don’t you know?’ I’d hear it whenever someone would talk about their manicures or complain about their car breaking down,” she says. “‘Don’t you know that children are stepping on land mines and having their arms and hands blown off right now?’”
But the last thing she wants is to become an angry, ranting ex-pat. “My life is no different than anyone else’s,” Frawley says. “I’ve just chosen to do this with mine.”
