This document was prepared by Academy member James D. Smith, MD, as a handout for his instruction course by the same title. He presented this course for several years at the AAO- HSNF Annual Meeting & OTO EXPO, In 2008 , Dr. Smith received the Distinguished Award for Humanitarian Efforts.
Medicine in developing countries certainly is a lot different than in the U.S. First of all, there is usually a shortage of physicians. Second, the resources spent on medical care may be only a few dollars per capita per year compared to the U.S. spending of thousands.
Are you frustrated and stressed from medical practice in the U.S.? Do you enjoy travel or have a yearning to help others? If so, why not try a volunteer vacation?
Multiple opportunities are available for someone who would like to experience a foreign culture in the setting of medical practice. Before deciding whether this type of vacation is for you, there are several questions one needs to honestly ask and answer.
1. Why do I want to do a volunteer vacation?
Any or all of the above may be suitable reasons to decide to go.
2. What are my interests?
3. Where do I feel comfortable going?
4. What are my shortcomings? A very important question to ask and analyze honestly. Ask your colleagues, office personnel, or scrub nurse if you're not sure.
If any of these describe your actions, can you control them? If not, think twice before you take a trip.
5. Practical questions
6. What potential opportunities are there?
Once you have answered all the previous questions and found an opportunity, what is the next step? Start planning now! It will take 6-12 months to get everything in place. If you go on an organized trip, this may take less time, but if you try to set something up on your own, it can be agonizingly slow. Round trip communications may take two months or more to some countries in Africa. E-mail may help, but many countries will not have it.
1. Travel documents: First, you will need a passport if you don't have one. Applications are available at your local post office. When you get your passport photos, get extra prints; you will need them for visas, work permits, and other documents. A good travel agent can help with airline tickets and visas, if necessary. Be sure and check the Sunday travel section in your local newspaper for fares. Sometimes one can get real bargains on consolidation fares. I have had round trip tickets to Singapore for less than I can travel to Washington, DC.
2. Practice needs: Depending on where you are going, what you are doing, and under whose auspices you will be working, you may need a medical license. Most organizations will help arrange this, but you will need copies of your medical degree, current licenses, etc. Check with your malpractice carrier and your host country to see if extra coverage is needed.
3. Medical needs (personal): Contact a local travel clinic or the Centers for Disease Control for information on what immunizations and medicines you will need in the area that you plan to visit.
1. Local living conditions - Standards of cleanliness, housing, etc. may be much different than what we are used to. If you have never been to a developing country, be prepared for a big difference.
2. Medical/hospital conditions will be much different. No ICU. Two patients to a bed. Beds that look like they are from the '20s. Large crowded wards. The smell of disinfectant.
3. Operating facilities - These facilities may be primitive or even makeshift on some trips. Anesthesia machines may be from the 1930s.
4. Schedules - Clinics and OR clinics may have overwhelming numbers, and you may have to decide who will and will not get surgery. It can be heartrending to turn down a pleading patient. The OR schedules may be unrealistic, or you may even consider them unfair.
5. Who is eligible for treatment? You may want to help the poor but may be pressured to take care of the local VIPs if your expertise is perceived to be otherwise unavailable. How will you handle a delicate situation?
6. Overwhelming numbers of patients: the needs may seem endless, but help where you can and it will be appreciated.
7. Different view of patient care: this is something I can't really explain. It may be that in most countries the physician is an authority figure and we are used to considering patient care as a partnership.
8. Finances available for medical care. In most developing countries, finances are meager at best. A return visit to the clinic may cost 1 or 2 weeks of the family income. A CT scan may cost the patient 6 months' income. Be sensitive.
9. Be sensitive!
Surgery in an unfamiliar setting may be out of your comfort zone. It can be risky. The first time I visited China I was hesitant about doing surgery. Anesthesia was primitive. They did more clefts in a year than I had in my career, and I was supposed to demonstrate to them. In discussing this with a more junior staff person via an interpreter, he told me that the previous team had not done much surgery and how disappointed they were. He said, "We never get to leave here and see anyone else operate." I realized that if I did cases, and it was different, he might pick up some ideas. If I struggled with a difficult case, he could think to himself, "I could do that better," and feel good about his own skills. I think some of both happened. I had a wonderful time and developed a close bond with him. Try it; you will like it!
1. Bring any favorite or special instruments.
2. Bring your own sutures, gloves, shoe covers, etc.
3. Anesthesia - What is available? Local vs. general. This is probably the scariest aspect unless you can take an anesthesiologist with you.
4. Fit in with the host's method of scrubbing, prepping, and draping.
5. Scrub nurses may not gown or glove you and may not pass instruments. That may be the assistant's responsibility. Don't insist that they accommodate you.
6. Watch how your host does things.
7. Be prepared to demonstrate and share experiences.
8. Have your host do a case and assist him.
9. Remember your host may not do things "the American Way," but that is okay.
10. Language barriers - It is best if there is some type of interpreter in the OR. Scrub and circulating nurses may not speak English. Try to learn key words for knife, suture, hemostat, etc. in the local language.
11. Speak slowly and distinctly - This is the most important thing when communicating with people to whom English is a second language. It may even be important in some primarily English-speaking countries.
12. Be conscious of resources.
13. Be prepared to give talks and demonstrations on surgical technologies.
1. What is your purpose for going?
2. What would you like to achieve?
3. Show a genuine interest in the country, people, and patients you are visiting.
4. Keep a sense of humor.
5. Be flexible.
6. Adapt to the unexpected.
Receive many benefits to help you in your professional pursuits: shape the future of the specialty, manage the business side of your practice more smoothly, and more.
Do you enjoy travel or have a yearning to help others? If so, why not volunteer for humanitarian efforts?