Hi everyone, good morning or good afternoon, wherever you are. My name is Alain, I’m French by nationality, but I’ve been living in Norway for the last 11 years. I joined Médecins Sans Frontières (MSF) in 2006 and have worked extensively in the field, being deployed on 30 different assignments across the world.
In 2011–2012, I decided to take a break for something important—family. My partner and I had twins, who are now eight years old. After that, I began working on bringing mentoring and coaching into MSF. Last year, at the onset of the pandemic, I took on a new role as the HR Director for MSF Norway.
Today, I’m going to share some slides with you and talk about a personal story—one that makes me believe we could have saved even more lives. We are always very self-critical at MSF, and I will also share how we are trying to become a better learning organization. I’d love to hear your insights on learning cultures—how you prioritize learning in your organizations and how we can improve.
Haiti, 2010–2011: Responding to a Cholera Outbreak
I want to take you back to one of my last assignments in Haiti during 2010 and 2011, where we faced a major cholera outbreak. I realize now that discussing a disease outbreak in the midst of the COVID-19 pandemic may not be ideal, but while there are some similarities, there are also significant differences. Cholera is caused by bacteria, not a virus, and it spreads through contaminated water rather than being airborne.
In 2010, I was part of MSF’s emergency unit. We were deployed in less than 24 hours, meaning I could be put on a plane with very short notice. That’s exactly what happened when the cholera outbreak started. This is a picture I took upon arriving in Port-au-Prince, the capital of Haiti. The conditions were perfect for cholera transmission—crowded urban areas with poor sanitation.
A Volatile and Complex Context
Haiti was, and still is, a highly volatile, uncertain, complex, and ambiguous environment. This is a picture I took during the cholera response—protests and demonstrations were frequent. In the photo, you see a road blockade where tires are burning. People were protesting against the government.
At that time, only MSF and the International Committee of the Red Cross were allowed to cross these barricades. Responding to an outbreak in an unstable context like this is extremely challenging.
This was my third time in Haiti that year. In January 2010, I was deployed for the earthquake response. Later in the summer, I returned as a country representative for a few months, and then I was called back later in the year for the cholera outbreak.
The Spread of Cholera
The first cholera cases were reported in October 2010 in a rural area outside of the big cities. Just four weeks later, the outbreak had spread rapidly, and MSF had scaled up operations across the country.
Eight weeks after that, in January 2011, the situation was out of control. The map below shows all the MSF operations related to cholera—cholera treatment centers, isolation centers, exploration teams identifying new cases, and logistical support such as helicopter transportation to reach remote areas. The outbreak spread fast, and our response had to be just as fast.
Responding to Cholera
Managing a cholera outbreak is all about data—having real-time information on how the disease is spreading, which populations are most affected, and how transmission patterns evolve. Cholera symptoms can appear within 12 hours to five days after exposure, and patients can die within two hours if untreated. Rapid response is crucial.
The key to stopping cholera is twofold: breaking the chain of transmission and treating infected patients. This is similar to COVID-19 in principle, though the mode of transmission is different. Cholera spreads through contaminated water, while COVID-19 is airborne.
We set up cholera treatment centers, which had to be built within days. Unlike COVID-19, cholera patients cannot isolate at home. They must be treated in dedicated centers to prevent further spread.
Because cholera patients die from dehydration, we needed large-scale water production to provide clean drinking water, disinfect contaminated areas, and rehydrate patients. The photo below shows our team building a water purification system—a vital part of the response.
The Personal Impact
This was one of the most intense missions of my life. I worked for two months straight, seven days a week, with no days off, often working 12 to 16 hours a day. My colleagues were equally exhausted.
After two months, I finally flew back home, stopping in Brussels for a debriefing at one of our headquarters. During that debriefing, someone placed a thick report in front of me—an evaluation of MSF’s previous major cholera outbreak response in Zimbabwe in 2007–2008.
At that moment, I felt ashamed and frustrated. Why was I only receiving this information now, after my mission had ended? This report contained valuable lessons that could have helped me and my team respond faster. Why hadn’t I thought to ask for it before deploying? Why wasn’t this knowledge readily available?
Lessons Learned
Despite our challenges, MSF treated over 60% of all cholera patients in Haiti. By February 2011, we had treated over 110,000 patients, with a case fatality rate of just under 2%. In comparison, cholera outbreaks can have fatality rates as high as 10–15%.
However, I believe we failed in one key area: making operational knowledge accessible faster. If I had had access to that Zimbabwe report earlier, we could have reduced the case fatality rate by even 0.1% or 0.2%, which means hundreds of additional lives could have been saved.
Improving MSF’s Learning Culture
At MSF, learning is not just about medical knowledge—it’s about operational knowledge, contextual understanding, and experience. Learning must happen between people, not just in classrooms.
We have six operational headquarters, 33 major offices, 45,000 employees, and work in 60–70 countries. Structurally, we are as complex as a multinational corporation, which creates challenges for knowledge sharing.
To address these challenges, we are focusing on:
- Encouraging peer-to-peer learning, mentoring, and coaching.
- Developing communities of practice for knowledge sharing.
- Expanding the use of technology to create a single, accessible source of truth.
- Ensuring equal access to learning for all employees, regardless of location.
- Creating an environment where people have dedicated time for learning.
Final Thoughts
Ultimately, our ability to save more lives depends on continuously developing our learning culture and making knowledge sharing a priority. It’s not just about classroom training—it’s about people learning from each other in real time.
Thank you for your time today. I’d love to hear your thoughts. How do you prioritize learning in your organization? How do you make knowledge sharing more effective?