My name is Tejshri Shah and I am the head of the medical unit of Médecins Sans Frontières UK, the Manson Unit. When asked to be a guest blogger for the BMJ and help promote the BMJ Christmas Appeal for MSF, my mind raced back to my first mission and a little boy, who for the purposes of this letter, and to protect his identity, I will call A.

In 1999, I was enjoying summer even more then normal after the hard slog of studying and working to obtain my membership to the Royal College of Paediatrics and Child Health. That autumn, I left the comforting structure of the NHS and went to work on an MSF project in Sudan.

I was the only doctor for miles, and the best tool I had was my stethoscope. In my second week A’s mother came in, carrying him in her arms. He was a young baby, incredibly thin and very weak. Despite the seriousness of his condition, his mother hadn’t been able to come earlier because the rains had made the dirt tracks and rivers impassable. My heart sank. He had come all this way, so late and so close to death, and I was not hopeful. We gave him antibiotics, nursing care and nutrition. After a fortnight, his fever subsided but he remained weak. Further illness and complications (that we were luckily able to treat in time) meant that it was a full month before he finally started to gain weight. Despite this improvement, something troubled me – something did not feel right, but I just couldn’t place it.

The answer came in A’s second month of admission when he suddenly smiled for the first time. This was what had been missing. I had been so absorbed with his medical condition that I had not noticed the absence of his smile.

I became acutely aware that the smile heralded his discharge from the hospital. Yes, he was a bit older and a bit stronger, but he was returning to a life in which he would be at the mercy of diseases such as leishmaniasis and tuberculosis as well as the brutal effects of poverty and violence. It felt as if we had put a sticking plaster on a fracture, but left the bones broken.

This frustration remains, as for many people life is inhospitable and unjust. MSF cannot completely change the world but its staff strive to save lives, alleviate suffering and restore human dignity. These words may sometimes only reflect a moment in someone’s life, but it is these moments that keep me working for MSF almost 10 years on.

Tejshri Shah coordinates all the Manson Unit activities. She has been field based since 1999 and was previously strategic health adviser for MSF in Amsterdam before taking up this role in May 2008.