Anyone with experiences with programs like Doctors Without Borders?

[linkin06]

Now that I recently actually passed "Basics", it makes it feel like this becoming an anesthesiologist thing actually might happen! One of my dreams and reasons for signing up for anesthesia was the possibilities of volunteering through some programs like Doctors Without Borders. Seems really rewarding to be able to help serve people in some extreme conflict zones. Has anyone had experiences? I searched and read a couple threads, but nothing really definitive seemed to get hashed out.

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[sleepallday]

The experience depends on the organization you go with. You want to go with a well funded group that has extensive experience with humanitarian work. So that the only thing you have to worry about on the mission is taking care of patients. My personal experience was great but exhausting. We worked pretty much everyday from 8am -10pm. The only opportunity I had to sight see was on the day I flew back to the states. But I knew before signing up that this was not going to be a "vacation" mission. Some of my friends have gone with other groups where they had quite a bit of leisure time.

The sad part was, that although we worked our asses off and really felt we helped some kids, all our efforts felt like only a drop in the bucket of what actually needed to be done. We turned away more then 10x's the cases then what we did. Very frustrating. But I guess one drop is better then no drops.

 

[supahfresh]

Now that I recently actually passed "Basics", it makes it feel like this becoming an anesthesiologist thing actually might happen! One of my dreams and reasons for signing up for anesthesia was the possibilities of volunteering through some programs like Doctors Without Borders. Seems really rewarding to be able to help serve people in some extreme conflict zones. Has anyone had experiences? I searched and read a couple threads, but nothing really definitive seemed to get hashed out.

Yes, I have worked for MSF/Doctors Without Borders. I did two missions with them: one to South Sudan and the other to Nigeria. I wrote a little about this on my website:
Sudan – Physician Travels

You have inspired me to write more on the topic.

 

[IMGASMD]

Yes, I have worked for MSF/Doctors Without Borders. I did two missions with them: one to Sough Sudan and the other to Nigeria. I wrote a little about this on my website:
Sudan – Physician Travels

You have inspired me to write more on the topic.

Thanks for sharing.

 

[Chip N Sawbones]

I've worked for Mercy Ships on their ship Africa Mercy as a carpenter, and I highly recommend them. The great thing about working with them is that they can bring a modern, fully equipped hospital with a competent staff to parts of West Africa that have no decent medical facilities at all. It's much nicer working where there's a full patient load, the electricity stays on, there's air conditioning, and the water actually works. The hospital on board is almost exclusively a surgical hospital (also optho and dental), so there's always plenty of demand for anesthesiologists. The cases include lots of ortho work to treat rickets, VVF repair, lopping off massive benign tumors, cleft lip/palate repair, and releasing burn contractures.

Ship life is crowded but a lot of fun. There are people from about 50 different countries on board, all of whom are volunteers. The Africa Mercy is it's own self-contained town. There's a store, library, barbershop, and coffee shop on board. The food is pretty good. Mercy Ships is a Christian organization. You don't have to be a Christian to work there, but you do need to be cool with it. Some doctors are only there for two weeks while they're on vacation from their regular jobs, others live on their ship and raise their families on board.

I'd be glad to answer any questions about ship life. I don't know as much about the medical side, since the ship was under construction for most of the time I was on board. I think the Africa Mercy is going to be in Guinea Conakry for the next year.

 

[supahfresh]

I've worked for Mercy Ships on their ship Africa Mercy as a carpenter, and I highly recommend them. The great thing about working with them is that they can bring a modern, fully equipped hospital with a competent staff to parts of West Africa that have no decent medical facilities at all. It's much nicer working where there's a full patient load, the electricity stays on, there's air conditioning, and the water actually works. The hospital on board is almost exclusively a surgical hospital (also optho and dental), so there's always plenty of demand for anesthesiologists. The cases include lots of ortho work to treat rickets, VVF repair, lopping off massive benign tumors, cleft lip/palate repair, and releasing burn contractures.

Ship life is crowded but a lot of fun. There are people from about 50 different countries on board, all of whom are volunteers. The Africa Mercy is it's own self-contained town. There's a store, library, barbershop, and coffee shop on board. The food is pretty good. Mercy Ships is a Christian organization. You don't have to be a Christian to work there, but you do need to be cool with it. Some doctors are only there for two weeks while they're on vacation from their regular jobs, others live on their ship and raise their families on board.

I'd be glad to answer any questions about ship life. I don't know as much about the medical side, since the ship was under construction for most of the time I was on board. I think the Africa Mercy is going to be in Guinea Conakry for the next year.

Very cool! I have always wondered about this group.

Good to know you can do a variety of time frames.

Likewise with Doctors Without Borders and I can answer questions about them. You can do very short missions if you are in surgery or anesthesia.

 

[2Fast2Des]

I'd love to do some volunteering as well, but I gotta say I'm a bit spoiled, really need running water, decent bathroom and not worry about getting attacked. Volunteering on these ships sounds like something I could do.. How does one get into it? And what kind of licensing do you need?

 

[leaverus]

I'd love to do some volunteering as well, but I gotta say I'm a bit spoiled, really need running water, decent bathroom and not worry about getting attacked. Volunteering on these ships sounds like something I could do.. How does one get into it? And what kind of licensing do you need?

yeah same here, that's kinda what's held me back in the past

 

[Chip N Sawbones]

I'd love to do some volunteering as well, but I gotta say I'm a bit spoiled, really need running water, decent bathroom and not worry about getting attacked. Volunteering on these ships sounds like something I could do.. How does one get into it? And what kind of licensing do you need?

You can apply to volunteer with Mercy Ships on their website, mercyships.org. I should warn you that the ship is still tied up to an African quayside, so sometimes Third World problems can encroach on ship life. For example, shortly after I left, the Africa Mercy crew had to go on severe water rationing for a few months as there was no water supplied to the ship. At the time they were in Freetown, Sierra Leone, a city with chronic water shortages. I think the rule was something like one toilet flush per day and a shower every week or two. Usually that isn't a problem, and the bathrooms are nice. Security on the ship is excellent. The guards are Gurkhas, they're about the only paid employees on board, and they won't let anything happen to you. This story might have grown a little before I heard it but in Togo a couple of the crew went for a walk on the beach with one of the Gurkhas. Two guys with machetes came up to them and tried to rob them. Bad idea. The Gurkha charged right at them, turned them inside out, and then looked back at the other crewmen a little disappointed that nobody else wanted to join in the fight.

As far as licensing goes, you need to have a license to practice medicine in your home country. Mercy Ships generally wants at least two years of experience, but when I was there there were a couple of anesthesiology senior residents who joined us for a two week stint, probably as some kind of away elective from their home program.

 

[Planktonmd]

The experience depends on the organization you go with. You want to go with a well funded group that has extensive experience with humanitarian work. So that the only thing you have to worry about on the mission is taking care of patients. My personal experience was great but exhausting. We worked pretty much everyday from 8am -10pm. The only opportunity I had to sight see was on the day I flew back to the states. But I knew before signing up that this was not going to be a "vacation" mission. Some of my friends have gone with other groups where they had quite a bit of leisure time.

The sad part was, that although we worked our asses off and really felt we helped some kids, all our efforts felt like only a drop in the bucket of what actually needed to be done. We turned away more then 10x's the cases then what we did. Very frustrating. But I guess one drop is better then no drops.

This is the main issue with all these organizations and missions, what they do does not resolve the problem and has no lasting effect.
It's like going to a poor hungry community and giving people food for a period of time then leaving them to their hunger.
The resources should probably be spent on building infrastructure or educating local health care providers so they can start taking care of themselves.
People who go on these excursions do get some fulfillment and satisfaction with their adventures but unfortunately the results are pretty negligible.

 

[vector2]

This is the main issue with all these organizations and missions, what they do does not resolve the problem and has no lasting effect.
It's like going to a poor hungry community and giving people food for a period of time then leaving them to their hunger.
The resources should probably be spent on building infrastructure or educating local health care providers so they can start taking care of themselves.
People who go on these excursions do get some fulfillment and satisfaction with their adventures but unfortunately the results are pretty negligible.

You're painting a false dichotomy since the first world has enough money to do both, and indeed organizations like Gates foundation have enough resources to effect change at an infrastructure level. However, I'd bet if you asked the thousands and thousands of people who have had life-changing surgery, they might have a different opinion on whether the gift to them was "negligible"

I take my hat off to the docs and other providers who go on these sort of trips, cause I sure as hell prefer air conditioning, Netflix, and being able to flush the toilet whenever I want.

 

[Aether2000]

The main problem with MSF is the time commitment. For anesthesiologists, the least time commitment is 6-8 weeks, which generally uses up all vacation for the entire year, if you have that much, and is difficult to arrange with an employer. If you are between jobs or doing locums, then it does work. From the MSF website: Time requirements:

• Availability for a minimum of 9 to 12 months
  With the exception of surgeons, anesthesiologists, nurse anesthetists, and ob-gyns who may be accepted for shorter assignments of six to eight weeks.
  Because of the degree of responsibility MSF aid workers are expected to assume, the time needed to acclimatize to a project and context, and the need for continuity among field staff for the benefit of both our locally hired staff and patients, MSF requires a nine to 12 month time commitment for most profiles. Due to the nature of their workload while in the field, a shorter time commitment is required of surgeons, anesthesiologists, nurse anesthetists, and ob-gyns.

 

[pgg]

This is the main issue with all these organizations and missions, what they do does not resolve the problem and has no lasting effect.
It's like going to a poor hungry community and giving people food for a period of time then leaving them to their hunger.
The resources should probably be spent on building infrastructure or educating local health care providers so they can start taking care of themselves.
People who go on these excursions do get some fulfillment and satisfaction with their adventures but unfortunately the results are pretty negligible.

There's some truth to what you're saying, but I don't entirely agree. It's true that we're not going to drop in for a week and fix someone's hypertension or diabetes or other chronic illnesses. Nor their malnutrition. Maybe someone gets dewormed but they're just going to get re-wormed in a few months or a year. They're still drinking dirty water, getting bitten by mosquitoes, and fertilizing the crops with night soil.

However even the most cynical person in the world shouldn't deny that there are some lifechanging things we can do. Operation Smile is a great example. It's really hard to overestimate how much impact it has on a kid to get a cleft palate fixed. No, Operation Smile doesn't fix the host nation's inability to take care of their own people, but somehow, a couple months out, I doubt that the parents and siblings and friends and neighbors are sad about that. The kid, of course, is too busy drinking through a curly straw to care about big picture stuff.

The resources should probably be spent on building infrastructure or educating local health care providers so they can start taking care of themselves.

This sounds great but I've spent a lot of time over the years building infrastructure and educating local health care providers (I'm actually overseas doing it right now). It's a mixed bag. Sometimes you can improve things. Sometimes you can't. Usually you can't because the stumbling blocks aren't resources so much as culture and a wide, wide gap between you and the people you're training. If you don't go in with exceptionally modest goals it's agonizingly demoralizing. And you've got to be careful because there is always, always some amount of host nation anxiety if not shame that they need the help in the first place, and this manifests in odd pockets of resistance and passive aggressive behavior.

If you're the sort who gets the least bit frustrated with a med student or intern who argues with you, I suggest you never ever attempt to change the smallest habit of a senior physician in the 3rd world.

It's the same set of problems that torpedo efforts at nation building. Over the last 20 years of my life I have gradually come 180 degrees on this and currently believe that whether you're trying to build a nation or a modern(-ish) healthcare system, going there to pour some concrete and show 'em how it's done just doesn't seem to work real well. There's no shortage of true believers on our side who think it does, or it will, and there are usually a couple of willing people on their side who are game, but my experience hasn't been encouraging. Maybe I set the bar too high and should savor the small victories more.

Maybe the better answer is to be a good example in our own world, and let them come to us when they see how great our lives are and want to learn how. I am often left thinking that what most of those places need is for an entire generation of their medical students and nursing students to leave, train in a first world nation, go back, wait for the older generation to retire, and take over.

There are some other issues that maybe I'll write about someday when I'm a little further away from this project and have had some time to think about it some more. Anyway, on the whole I'd rather just show up, fix some cleft palates and mitral valves, do some fire & forget ortho/uro/gensurg/ENT, make some friends, eat some local food, have some GI distress, and then go home.

Caveat ... I work for a GO, not a NGO, so my experience is skewed toward certain countries and certain kinds of encounters.

 

[AdmiralChz]

This is the main issue with all these organizations and missions, what they do does not resolve the problem and has no lasting effect.
It's like going to a poor hungry community and giving people food for a period of time then leaving them to their hunger.
The resources should probably be spent on building infrastructure or educating local health care providers so they can start taking care of themselves.
People who go on these excursions do get some fulfillment and satisfaction with their adventures but unfortunately the results are pretty negligible.

I feel you. The best organizations partner closely with in-country personnel and properly train them during missions. You see this with aesthetic surgery and dental missions where hopefully after a few visits and help the work can continue after the mission leaves.

The organization I worked with would always say their number 1 goal is put themselves out of business in this way.

 

[Planktonmd]

There's some truth to what you're saying, but I don't entirely agree. It's true that we're not going to drop in for a week and fix someone's hypertension or diabetes or other chronic illnesses. Nor their malnutrition. Maybe someone gets dewormed but they're just going to get re-wormed in a few months or a year. They're still drinking dirty water, getting bitten by mosquitoes, and fertilizing the crops with night soil.

However even the most cynical person in the world shouldn't deny that there are some lifechanging things we can do. Operation Smile is a great example. It's really hard to overestimate how much impact it has on a kid to get a cleft palate fixed. No, Operation Smile doesn't fix the host nation's inability to take care of their own people, but somehow, a couple months out, I doubt that the parents and siblings and friends and neighbors are sad about that. The kid, of course, is too busy drinking through a curly straw to care about big picture stuff.




This sounds great but I've spent a lot of time over the years building infrastructure and educating local health care providers (I'm actually overseas doing it right now). It's a mixed bag. Sometimes you can improve things. Sometimes you can't. Usually you can't because the stumbling blocks aren't resources so much as culture and a wide, wide gap between you and the people you're training. If you don't go in with exceptionally modest goals it's agonizingly demoralizing. And you've got to be careful because there is always, always some amount of host nation anxiety if not shame that they need the help in the first place, and this manifests in odd pockets of resistance and passive aggressive behavior.

If you're the sort who gets the least bit frustrated with a med student or intern who argues with you, I suggest you never ever attempt to change the smallest habit of a senior physician in the 3rd world.

It's the same set of problems that torpedo efforts at nation building. Over the last 20 years of my life I have gradually come 180 degrees on this and currently believe that whether you're trying to build a nation or a modern(-ish) healthcare system, going there to pour some concrete and show 'em how it's done just doesn't seem to work real well. There's no shortage of true believers on our side who think it does, or it will, and there are usually a couple of willing people on their side who are game, but my experience hasn't been encouraging. Maybe I set the bar too high and should savor the small victories more.

Maybe the better answer is to be a good example in our own world, and let them come to us when they see how great our lives are and want to learn how. I am often left thinking that what most of those places need is for an entire generation of their medical students and nursing students to leave, train in a first world nation, go back, wait for the older generation to retire, and take over.

There are some other issues that maybe I'll write about someday when I'm a little further away from this project and have had some time to think about it some more. Anyway, on the whole I'd rather just show up, fix some cleft palates and mitral valves, do some fire & forget ortho/uro/gensurg/ENT, make some friends, eat some local food, have some GI distress, and then go home.

Caveat ... I work for a GO, not a NGO, so my experience is skewed toward certain countries and certain kinds of encounters.

I didn't say it wasn't a nice thing to do surgery on a few kids and improve their quality of life, but this is not addressing the problem as you eloquently stated. This is basically charity work not that different from giving a sandwich to a hungry person, or maybe providing free health care to someone without insurance here at home.
Actually if charity is the goal then there is plenty of opportunity right here in the U.S.

 

[linkin06]

I didn't say it wasn't a nice thing to do surgery on a few kids and improve their quality of life, but this is not addressing the problem as you eloquently stated. This is basically charity work not that different from giving a sandwich to a hungry person, or maybe providing free health care to someone without insurance here at home.
Actually if charity is the goal then there is plenty of opportunity right here in the U.S.

Yes it’s called Medicare reimbursement!