Volunteering on an Overseas Humanitarian Surgical Mission

There are many things to consider when contemplating an overseas volunteer anesthesia trip. The rewards of such work are great, for both the anesthesiologist and the local community which is being served. It is important to give serious consideration to the idea before making such a commitment.

First, consider whether your own health permits such a trip. Although you are obviously traveling with a team of medical professionals, it is often (but not always) to a fairly remote area in a  less developed nation (LDN). That means access to medical care is limited. Chronic health concerns, especially if serious, may be difficult to treat. Consider as well the environment  at your destination. Issues may include everything from temperature (extreme heat and humidity, for example), to air quality and altitude. This may influence your choice of where to travel. Remember also that travel often includes prolonged time on long-distance flights, followed by ground transportation on roads that may be less than ideal. Expect some sort of gastroenteritis, no matter how careful you are.

Second, there are real financial considerations. Time away from OHSU will likely result in a loss of income, similar to vacation. The cost of the trip varies, with some trips requiring that physicians pay all of their expenses, and others requiring a “trip participation fee” of an amount significantly less than the total trip cost. In most cases, expenses are tax deductible, and APOM policy may allow use of your CME (meeting) time and money for such trips. If you are responsible for a resident’s education in a mentor role on a trip, non-clinical time may be an option as well.

The most important thing to consider is the type of cases to be performed. Conditions vary at the host locations. Trips may take place in a clinic, specialty hospital, major referral hospital or a small rural hospital. Equipment and medical supplies are likewise varied, from newer to older and held together with duct-tape. As such, it is imperative that the anesthesiologist feel very comfortable and confident in taking care of the types of patients to be served. If your trip is doing cases you feel uncomfortable doing at OHSU, you certainly would not want to do them under sub-optimal conditions.

Flexibility is paramount when doing medical mission work. Roles are less well defined, and the team is more important than any one individual. Egos should be left at home, as the ultimate success of the trip is dependent on smooth functioning. Respect for local customs, values and culture is imperative. Some trips may involve working along side local healthcare professionals, providing formal or informal lectures. Translators are always provided by the host country, so although speaking a native language can be helpful (and fun!), it is not necessary. Other trips will primarily be about patient care. Hours are often longer than at OHSU, and accommodations at the end of the day may range from housing with local families (i.e. members of local civic organizations) to guest  houses or hotels.

You may be asked to limit your own personal baggage, so that the team can use your baggage allowance for medical supplies. You will also need to make sure you have those things that you always want to have, but may not be brought on the trip. If you are traveling with an organization based out of town, you may not even know exactly what is being brought in terms of anesthesia supplies.

Humanitarian work is extremely rewarding. You may return from a trip exhausted, and perhaps a few pounds lighter thanks to the local bacterial gut flora, but you will also likely feel as though your emotional batteries are recharged as a result of making such a huge difference in someone’s life. I have taken care of patients that have traveled for 2 days and slept outside the hospital on a piece of cardboard, in order to be treated. You come to appreciate the waste of our “advanced” health care delivery system. I have never heard of patients saying anything other than “thank you” for the care they have received. No complaints about long NPO times, or waits in the pre-op area!

I have also enjoyed the opportunity to work with a medical student, resident or fellow in a unique way. You work along side him/her daily for a week or more. You see their growth and development in a challenging environment. They often mature tremendously. It is my favorite part of being a clinical educator.

As you begin your search for a trip, ask yourself the following questions:

1. Are you sure you really want to do this?
2. What kind of cases do you want to do, or does it not matter?
3. Do you have a preference as to where you want to travel? Or where you don't?
4. You will likely be gone 1.5-2.5 weeks. Will that work for you? I recommend a minimum of 2 days back home to recuperate/catch-up before returning to work.
5. Are you current on immunizations?
6. Do you have a passport that will not expire within 6 months of your expected return date?
7. Are you prepared to "rough it"? Long flights, bumpy roads, lay-overs in airports, and room-mates who you have never met?

If you still want to go, congratulations! Here are some things to do well in advance of a trip:

1. Research organizations to determine how they do business.
2. What types of cases do you want to do, or does it not matter?
3. Are there countries you want to travel to, or don't want to travel to?
4. What are your expectations? Expenses? Housing?
5. Apply as a volunteer with 1 or more organizations, and get approved. Expect application forms, letters of reference and copies of medical school diploma, residency completion, board certification and state license, at a minimum.
6. Secure time off as appropriate.
7. Renew your passport, if applicable.
8. Determine if you will need a visa to your destination country. The sponsoring organizations usually obtains this for you.