Did I do "too much" when volunteering abroad?

[drizzt3117]

It looks like the funnest thing in the world. You go to Wisconsin right?

Yep. it is pretty fun; I don't think being a medical student automatically makes you qualified to do it, though.

I'm not saying the kid should write about in his PS or even do it, but I don't think he's putting patients at risk, though.

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[lalalaaaaaa]

Too often, these international pediatric bedside art missions are simply glorified vacations.

This is it. Most of these trips are excuses for a vacation intended to look like altruism. I'm not totally against them, but the $2000 spent on a plane ticket would be better used giving directly to the community instead of to go and visit (That is if your intentions are solely to help the community.). You can do just as much good at a local homeless shelter or clinic, seems like the reason to go to Africa or South America is to travel.

There is a compelling argument for the experience of visiting these places though.

 

[MT Headed]

What kind of "difference" do you expect to make? Are there not pediatric patients in need of bedside art in your own community? Don't you think the $2000 you'd spend on a plane ticket could be put to better use funding art supplies to send abroad? What makes you think there aren't already locals living in these foreign countries who are qualified to perform pediatric bedside art? Too often, these international pediatric bedside art missions are simply glorified vacations. You should stick to providing pediatric bedside art in your own community.

Thank you, candav. I literally LOLed for three minutes and people around here are looking at me funny.

 

[areserine]

Maybe I'm reading this wrong, but are volunteers not allowed to do things like take patient temperatures and blood pressure? If I were asked to do during volunteering I would have trusted that my supervisors knew that it was allowed.

 

[music2doc]

Maybe I'm reading this wrong, but are volunteers not allowed to do things like take patient temperatures and blood pressure? If I were asked to do during volunteering I would have trusted that my supervisors knew that it was allowed.

Generally, hospitals don't even want volunteers taking bps and temps with a machine. That said, if someone is supervising you, it's probably not a huge deal.... Frankly, our nurses used to let volunteers do it in Triage all the time (until the administration got involved, that is). The issue there has more to do with insurance than actual pt safety.

The problem is really more with invasive or potentially harmful procedures. At the free clinic where I volunteer as basically a medical assistant/nurse (using my EMT license), I train volunteers w/o any sort of medical background (besides being pre-med/pre-PA/pre-....something health-related) to do vitals and basic H&Ps. At the same time, I am watching them like a hawk to ensure we don't miss something important and I regularly QA their skills because if they screw up, it's my license, my supervising RN's, the staff doc's, and the medical director's licenses that are on the line. Our medical director is fine with the way we run it, but we are careful to ensure that our unlicensed volunteers work under supervision and do not do anything that requires training beyond what we can offer in a brief orientation (i.e., they don't do wound care, glucose checks, etc., although they can certainly watch us do them and I will occasionally let one I trust do a UA and then interpret the strip for the doc).

It is honestly should be more up to the supervisor to ensure s/he is not giving you responsibilities beyond your "job description;" however, even in staff positions, I have seen RNs assign duties inappropriately (e.g., asking an ED registrar to titrate a patient's O2 levels while in a patient's room after being told the patient was having difficulty breathing). Consequently, it is critical that you develop a gut instinct for what you should (not) be doing.

 

[Deekle]

This is it. Most of these trips are excuses for a vacation intended to look like altruism. I'm not totally against them, but the $2000 spent on a plane ticket would be better used giving directly to the community instead of to go and visit (That is if your intentions are solely to help the community.). You can do just as much good at a local homeless shelter or clinic, seems like the reason to go to Africa or South America is to travel.

There is a compelling argument for the experience of visiting these places though.

I spent most of my life in Ecuador, South America as the son of missionaries. I can say with some authority that missions trips are seldom "vacations". We put you to work. Sure, we'll take you to the tourist spots for some R&R, but you earn it by doing the good works most people come to do, be it a building project, medical or other.

The cultural experience of seeing first hand how the rest of the world lives is worth the 2k plane ticket. If more people in this country realized how truly blessed they are, they would be much more willing to do something to affect change, even in their own communities.

 

[theseeker4]

I spent most of my life in Ecuador, South America as the son of missionaries. I can say with some authority that missions trips are seldom "vacations". We put you to work. Sure, we'll take you to the tourist spots for some R&R, but you earn it by doing the good works most people come to do, be it a building project, medical or other.

The cultural experience of seeing first hand how the rest of the world lives is worth the 2k plane ticket. If more people in this country realized how truly blessed they are, they would be much more willing to do something to affect change, even in their own communities.

The point is a 2-week trip to a village is more a vacation than any real help to the people at the village. Pretending the trip is a huge altruistic sacrifice bettering the lives of the less fortunate is absurd. Experiencing new cultures? Sure, though quite limited in scope with the 2-week limit. Seeing how other people outside the first world live? Absolutely, though again, very limited. Bettering the lives of those people to a greater extent than sending $2k in supplies, medications, etc. to the village would do? Give me a break.

They are glorified vacations, even if you spend a lot of time working on building a house or moving boxes of supplies from a truck to a makeshift hospital between watching doctors and nurses care for the villagers. The whole point of a 2-week "mission" is application fluffing and ego stroking. It takes a lot more than a trip like this to really make a difference, and a much greater difference could be made in an applicant's local community with less money.

 

[drizzt3117]

Omg... Can I plz do a UA???

Get over yourself.

Generally, hospitals don't even want volunteers taking bps and temps with a machine. That said, if someone is supervising you, it's probably not a huge deal.... Frankly, our nurses used to let volunteers do it in Triage all the time (until the administration got involved, that is). The issue there has more to do with insurance than actual pt safety.

The problem is really more with invasive or potentially harmful procedures. At the free clinic where I volunteer as basically a medical assistant/nurse (using my EMT license), I train volunteers w/o any sort of medical background (besides being pre-med/pre-PA/pre-....something health-related) to do vitals and basic H&Ps. At the same time, I am watching them like a hawk to ensure we don't miss something important and I regularly QA their skills because if they screw up, it's my license, my supervising RN's, the staff doc's, and the medical director's licenses that are on the line. Our medical director is fine with the way we run it, but we are careful to ensure that our unlicensed volunteers work under supervision and do not do anything that requires training beyond what we can offer in a brief orientation (i.e., they don't do wound care, glucose checks, etc., although they can certainly watch us do them and I will occasionally let one I trust do a UA and then interpret the strip for the doc).

It is honestly should be more up to the supervisor to ensure s/he is not giving you responsibilities beyond your "job description;" however, even in staff positions, I have seen RNs assign duties inappropriately (e.g., asking an ED registrar to titrate a patient's O2 levels while in a patient's room after being told the patient was having difficulty breathing). Consequently, it is critical that you develop a gut instinct for what you should (not) be doing.

 

[SLC]

Omg... Can I plz do a UA???

Get over yourself.

Seriously right? Talk about ego! How did music2doc's "free clinic" ever get by when he/she wanted a day off. Without constant "hawkwatching" I'm sure the patients were dropping dead right and left.

His/her licence as an EMT is not/was not anywhere near on the line for letting others take vitals ask history etc. EMT's don't even have a licence, but rather a certificate. And they are 100% reliant on an MD/DO to even exercise it. If they screw something up, they might lose their cert. if it's a total F%$#-up that a monkey would have recognized as a bad idea. Otherwise it's the supervising physician that will take the brunt of everything. They give these certificates to people in high-school for crying out loud.

Additionally, any provider is going to spot something fishy with incorrectly done vitals and re-assess themselves.
Any provider relies on an MA collected HPI about as much as I'm relying on a private helicopter to get to school each morning. The MA gets chief complaint and asks about HPI; the PA, MD/DO or NP then takes the Chief Complaint and does a much more thorough and detailed HPI and Review of Systems on top of it.

At my clinic I volunteered at as a pre-med (I was also an EMT-IA) I collected labs, administered meds (tried to keep the administered meds to those which fell under my scope, but some stuff never would (IM NSAIDS for example). I also did EKG's etc. We taught untrained pre-meds to do phlebotomy for a while, but stopped when one of them gave himself a needle stick injury.

Point is, it was more of a risk to our undertrained volunteers than it was to the patients.

But in the end, volunteers can legally do anything that a physician supervisor OK's them to do. They're quite literally operating as an extension of the physician's hands from a legal standpoint. Ethically, that might be different depending on just what you're doing. But nothing the OP mentioned comes close to putting a patient in any real danger unless it was done totally unsupervised. If the doc. felt confident in the volunteer, and was right there looking over his/her shoulder the whole time then what's the big deal.

Hell, we even trained volunteers to place IV's for a while there. With the caveat that if any of them ever put anything but NS or LR through them (and even then they had to get the provider's orders for the choice of fluid) then they would be fired immediately, no questions asked.

None of this stuff is as critical, or dangerous as you'd like to imagine, I'd let a good and responsible volunteer draw blood for me as a physician, as long as they were properly trained before hand, which takes a total of 5 minutes instruction and some skills practice to do in reality.

 

[MT Headed]

Careful about the license vs certificate thing, it is state dependent. I use my DOT EMT certificate when i'm on federal land like Yellowstone Park, but the state of montana board of medicine does issue state EMT Licenses for when i'm not on federal land.

 

[TheMightySmiter]

The issue with having volunteers do blood draws and start IVs isn't that they'll cause serious harm, but it's important to remember that the patient getting that stick is a person and not a guinea pig. I've worked in a hospital for two years, and if a patient gets a painful lab draw or IV, that IS what they'll remember from their hospital stay. It's much better to have a minimal number of experienced and properly trained staff doing these things, purely from the patient's perspective. It's one thing to have a med student or nursing student practice on patients, it's another to have any rando volunteer with a needle do it.

 

[NatrixCaelicola]

Do not talk about anything that you would not/ could not do here in the US. "Hands on experience" = taking advantage of poor people who are so desperate for some kind of medical care they let a shmuck like you and the doctor who let you practice on them.

As a former foreign aid worker, I am really irritated just reading about this... You never should have done it... if I was an ad com I wouldn't let you in.

I honesty have never understood the irritation with this. I'm willing to bet that the OP didn't wander around suturing people randomly but did what they were told to do and shown to do in a controlled situation leaving the doctor free To help others.

 

[SLC]

...It's one thing to have a med student or nursing student practice on patients, it's another to have any rando volunteer with a needle do it.

True, but you have to admit that someone who's been trained to do it (even if it wasn't an official phlebotomy course) and who does it on a semi-regular basis isn't just a "random volunteer with a needle".

 

[SLC]

Careful about the license vs certificate thing, it is state dependent. I use my DOT EMT certificate when i'm on federal land like Yellowstone Park, but the state of montana board of medicine does issue state EMT Licenses for when i'm not on federal land.

Interesting. In Utah (where I'm originally from) there are only certificates in EMS.

So do you practice independently in any way in Montana? In other words, can you push meds, etc without Medical Control approval? I understand Montana is much more rural than most of Utah so maybe things are done differently.

Still, my point remains. In a clinic, you're always going to be working under the medical director's license. If he/she is comfortable, and you've been trained, then legally you're in the clear. I'd never condone doing something someone is not proficient at, or comfortable with. But suturing simple lac's isn't exactly rocket science, and with close supervision and prior training (ie. not on patient's, on pig feet or something.) it's not something I think is completely unethical.

 

[TheMightySmiter]

True, but you have to admit that someone who's been trained to do it (even if it wasn't an official phlebotomy course) and who does it on a semi-regular basis isn't just a "random volunteer with a needle".

Even someone trained but who only does it once every week or two has a much higher likelihood of blowing a vein or having to move the needle around a lot. I'm just saying, why take the effort and time to train volunteers to do these things "semi-regularly" when you could have a smaller number of staff members doing it properly on a daily basis?

 

[MT Headed]

No, Montana isn't quite that wild west, lol. We still only practice under the medical license of our medical director. You made a lot of good points in your post, I just wanted to caution you that calling an EMT a certificate instead of a license not always true. Besides these are just terms and no matter what it's called an EMT will always have an extremely limited scope of practice.

 

[SLC]

Even someone trained but who only does it once every week or two has a much higher likelihood of blowing a vein or having to move the needle around a lot. I'm just saying, why take the effort and time to train volunteers to do these things "semi-regularly" when you could have a smaller number of staff members doing it properly on a daily basis?

Go to a busy inner-city free clinic, look at the wait times, look at the budget, it won't take long to see why we are willing to train people to do things. Also, please know that we didn't just take anyone interested and train them. Getting a volunteer position at our clinic was tough, and the medical director had to approve each and every one personally. Even then, not all of them were trained to do everything.

Have you learned phlebotomy, it's really not that big of a deal. I can't even remember a time when a volunteer blew a vein. And in addition, many who didn't take well to it simply refused to do those things (which was fine). Our volunteers were critical to being able to see the people we were trying to care for. We got help to be more efficient, they got good training that they wouldn't get elsewhere (many got jobs as MA's at regular clinics afterward), and the patients got efficient, high quality care. Win's all around.

 

[music2doc]

Seriously right? Talk about ego! How did music2doc's "free clinic" ever get by when he/she wanted a day off. Without constant "hawkwatching" I'm sure the patients were dropping dead right and left.

His/her licence as an EMT is not/was not anywhere near on the line for letting others take vitals ask history etc. EMT's don't even have a licence, but rather a certificate. And they are 100% reliant on an MD/DO to even exercise it. If they screw something up, they might lose their cert. if it's a total F%$#-up that a monkey would have recognized as a bad idea. Otherwise it's the supervising physician that will take the brunt of everything. They give these certificates to people in high-school for crying out loud.

Additionally, any provider is going to spot something fishy with incorrectly done vitals and re-assess themselves.
Any provider relies on an MA collected HPI about as much as I'm relying on a private helicopter to get to school each morning. The MA gets chief complaint and asks about HPI; the PA, MD/DO or NP then takes the Chief Complaint and does a much more thorough and detailed HPI and Review of Systems on top of it.

At my clinic I volunteered at as a pre-med (I was also an EMT-IA) I collected labs, administered meds (tried to keep the administered meds to those which fell under my scope, but some stuff never would (IM NSAIDS for example). I also did EKG's etc. We taught untrained pre-meds to do phlebotomy for a while, but stopped when one of them gave himself a needle stick injury.

Point is, it was more of a risk to our undertrained volunteers than it was to the patients.

But in the end, volunteers can legally do anything that a physician supervisor OK's them to do. They're quite literally operating as an extension of the physician's hands from a legal standpoint. Ethically, that might be different depending on just what you're doing. But nothing the OP mentioned comes close to putting a patient in any real danger unless it was done totally unsupervised. If the doc. felt confident in the volunteer, and was right there looking over his/her shoulder the whole time then what's the big deal.

Hell, we even trained volunteers to place IV's for a while there. With the caveat that if any of them ever put anything but NS or LR through them (and even then they had to get the provider's orders for the choice of fluid) then they would be fired immediately, no questions asked.

None of this stuff is as critical, or dangerous as you'd like to imagine, I'd let a good and responsible volunteer draw blood for me as a physician, as long as they were properly trained before hand, which takes a total of 5 minutes instruction and some skills practice to do in reality.

Sorry if that came off egocentric. It wasn't meant to be. EMTs here are licensed. It's not a "certificate." I have my lifeguard cert. It doesn't require CEUs nor does it require background checks, an application, etc. nor is it regulated by a division of the state's Board of Public Health. (All of which my EMT does/is.) As far as independence is concerned; RNs are licensed, but cannot push meds without medical control. We can follow standing orders within our scope of practice (just as an RN can), but that's pretty standard nationally I believe. The license vs. certification thing is really more a matter of terminology and emphasizing "EMS professionals" as "professionals" and not just some job any HS graduate can get.

As for before me? For the clinic I work in, we simply did not allow untrained volunteers access to patients. When a pre-med asked to volunteer s/he was immediately sent to Reception b/c s/he lacked the appropriate skills. Perhaps I have encouraged our licensed staff to be overly vigilant in watching the students, but it is honestly because I don't want something to happen that ruins the trust I've built with our medical director to offer our pre-health and pre-med students a bit "more" in terms of their clinical experience. I agree it's not rocket science, but at the same time, playing conservatively is generally the best policy.

As for providers double-checking everything the MA does, I wouldn't count on it. I've actually seen providers not do this at critical times both in our clinic and in the hospital where I work. I have also worked closely with our providers and gotten to be a vital part of making diagnoses and of catching patients about to stroke that, perhaps, someone without an EMS background might have missed. While I agree that an inexperienced individual is probably not a danger most of the time, I do not want something to happen and this experience to be lost for future students. It is something I guard jealously for good reason.

 

[SLC]

...EMTs here are licensed. It's not a "certificate." I have my lifeguard cert. It doesn't require CEUs nor does it require background checks, an application, etc. nor is it regulated by a division of the state's Board of Public Health. (All of which my EMT does/is.)

My EMT certification does require CEU's (not that I'm concerned about it anymore), background checks, application, etc. It is regulated by the Bureau of EMS, which is a division of the Utah Dept. of Health. License vs. Certificate is nothing but semantics based on location it appears.

 

[music2doc]

My EMT certification does require CEU's (not that I'm concerned about it anymore), background checks, application, etc. It is regulated by the Bureau of EMS, which is a division of the Utah Dept. of Health. License vs. Certificate is nothing but semantics based on location it appears.

I suspect it is. I do know that we have a greater scope of practice than the NREMT-B allows, but I wouldn't be surprised if Utah does as well. Mostly, it's been great for getting my foot in the door for great clinical experiences. At least in my area, you really can't get good clinical experience w/o some sort of cert/license. As I mentioned, there are a couple of opportunities that have arisen recently (specifically, two free clinics that will train volunteers to work at a near-MA level with no prior experience; it's something I've pushed for at both clinics and apparently they were open to it; other clinics in town have not been so willing to take the "risk").

 

[drizzt3117]

Just like p53 is the guardian of the genome, music2doc is the guardian of pre-med experiences...

Sorry if that came off egocentric. It wasn't meant to be. EMTs here are licensed. It's not a "certificate." I have my lifeguard cert. It doesn't require CEUs nor does it require background checks, an application, etc. nor is it regulated by a division of the state's Board of Public Health. (All of which my EMT does/is.) As far as independence is concerned; RNs are licensed, but cannot push meds without medical control. We can follow standing orders within our scope of practice (just as an RN can), but that's pretty standard nationally I believe. The license vs. certification thing is really more a matter of terminology and emphasizing "EMS professionals" as "professionals" and not just some job any HS graduate can get.

As for before me? For the clinic I work in, we simply did not allow untrained volunteers access to patients. When a pre-med asked to volunteer s/he was immediately sent to Reception b/c s/he lacked the appropriate skills. Perhaps I have encouraged our licensed staff to be overly vigilant in watching the students, but it is honestly because I don't want something to happen that ruins the trust I've built with our medical director to offer our pre-health and pre-med students a bit "more" in terms of their clinical experience. I agree it's not rocket science, but at the same time, playing conservatively is generally the best policy.

As for providers double-checking everything the MA does, I wouldn't count on it. I've actually seen providers not do this at critical times both in our clinic and in the hospital where I work. I have also worked closely with our providers and gotten to be a vital part of making diagnoses and of catching patients about to stroke that, perhaps, someone without an EMS background might have missed. While I agree that an inexperienced individual is probably not a danger most of the time, I do not want something to happen and this experience to be lost for future students. It is something I guard jealously for good reason.

 

[music2doc]

Just like p53 is the guardian of the genome, music2doc is the guardian of pre-med experiences...

I've been building a program for pre-medical students within the context of a community in need. Of course I would want to protect the work I've done to ensure it lasts after I leave. Sorry if that's not a "normal" pre-med activity and seems too involved or like I actually care about the work I've put in. My work has opened doors for students. I don't want those doors to slam shut the moment they lose the person advocating for them. Here, that is a very real possibility, although I am hopeful it will not happen. (It has happened in the past, however.)

 

[Sesom]

I would suture if a doctor offered it, no hesitation. I don't give %@$# what you guys think! I'd probably have the best suture too because I'm so confident.

 

[NatrixCaelicola]

I would suture if a doctor offered it, no hesitation. I don't give %@$# what you guys think! I'd probably have the best suture too because I'm so confident.

Given my manual dexterity and the fact my family raised me doing things with needles and such I'd be confident that with some training by a competent doc that I'd be fantastic at it too.

 

[MT Headed]

Given my manual dexterity and the fact my family raised me doing things with needles and such I'd be confident that with some training by a competent doc that I'd be fantastic at it too.

I spent several years sewing sails and canvas and other odd sewing jobs. Here's hoping some of those skills transfer. One thing I did learn during repeated shadowing is all the common sewing mistakes 4th year medical students make. I'll probably make them all myself, lol.

 

[Sesom]

Given my manual dexterity and the fact my family raised me doing things with needles and such I'd be confident that with some training by a competent doc that I'd be fantastic at it too.

That's the spirit! This thread has officially taken a positive turn. Is that what you use to suture with? Thread?