Doctors Without Borders

[Guevara M.D.]

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Hey everyone...I'm new here...this is actually my first post.

My question is this, I'm very much interested in practicing medicine in the Third World...particularly Africa or Latin America...but basically anyplace whose people need urgent medical care and have no one. One of the groups that I'm in love with is of course, Doctors Without Borders and I for one would love to be included among their volunteers.

But I have a couple of questions about it that I can't find the answer to...seeing as I've never met a doctor who did any work with Doctors Without Borders. So if anyone with more experience knows the answers hook me up...

1.) Loan Repayment Issue: how exactly do volunteer doctors work overseas with tens of thousands of dollars of debt hanging over their heads? Do they just wait to volunteer after they have paid all their debt? I always thought volunteering is potentially dangerous places was always a younger doctor game...but aren't young doctors still trying to pay off debt?

I'm poor...so I'll be in debt...and I would hate for my crushing debt to keep me out of Africa.

2.) Residency Choice: what is a good residency choice for someone who wants to work with Doctors Without Borders? I've been leaning towards Emergency Medicine because it seems that they work with a wide variety of unpredictable and tense situations...perfect for many places in the developing world. But are there other specialties that maximize chances of being accepted by MSF?

3.) Family: like any other mushy male I hope to one day find a woman and start a family...how feasible is that while working with MSF? Will I basically have to give up international work for a family?

4.) Specialized Residencies; are there residencies out there specifically targeted towards people who want to practice in the Third World?

5.) What's the deal with the World Health Organization? Do they actively send out M.D.s to areas needed? Or will I basically be a cubicle-bound, paper-pusher if I go to WHO?

I know these are a lot of questions...bear with me 🙂 and thanks in advance for the help.

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VCU/MCV Class of 2010...whoo hoo...

 

[Arctic Char]

hey, all good questions.

i can answer only a little. there do exist NGO's that have debt relief packages available if you sign on with them long enough. DWB contracts out its positions on set time periods of 1-2 years (i think for primary care), but may offer longer term positions if you desire. surgeons have much more flexibility with their time commitments with DWB, naturally. so residency training, for application to third-world medicine, would be sufficiently provided by a family practice, IM, EM, or gen. surgery. for the most part, international/3rd world medicine begins with community medicine, prevention, education, and treatment as necessary. a surgeon could not sustain a practice in a third world community, but could in a regional healthcare facility.

as far as education goes, Ben Gurion University in Israel (which is collaborated with columbia in new york) has the foremost educational program in international and global medicine. many of the students there do rotations with the WHO either before med school or during the summers -an elective/internship type experience. i'm told these are incredible experiences that allow one to travel all over the developing world, depending on what your interests are (epidemiology, prevention, education, etc etc).

PM me if you would like to discuss this topic more.

 

[unfrozencaveman]

Hey-

I know about as much as you do, but I'm in the same boat. As far as specialties go, it looks like if you are a physician, IM or EM are good choices, although I think they take people in tropical medicine and ID preferentially. Surgeons and anesthesiologists seem to be treated differently (shorter rotations, different locations-- mostly war related). I'm either going EM or trauma-surg just out of personal interest in those fields, so hopefully you're right. I had the same logic.

I'm not quite sure what to do with residency either-- you have to have international experience before you start, and I have no idea how one goes about doing that, or what qualifies.

And as for the logistical and personal issues... beats the hell out of me. Time to start embracing a lifetime of affairs with sexy french doctors, methinks.

 

[Arctic Char]

sexy . . . french . . . doctors . . . ?

apparently you really don't have any international experience. 😕

jk

 

[unfrozencaveman]

Very little. Plenty with desperation though. Should be an asset.

 

[skypilot]

One of my sisters works for them. Her residency was IM. She worked on TB in Thailand for a year and now she is working in Sudan on Leishmania for 6 months.

I would think that IM or FP would be a good background. Or of course general surgery.

I don't think it is too difficult to get a slot with them if you are a skilled doctor. As far as debt goes just live like you are in Africa in the US for a year or two and your debt will be paid off.

 

[waterski232002]

EM, IM, or FP would be most ideal... If you went the EM route, an International Medicine fellowship would be perfect for you. They are not boarded fellowships, but lots of EM programs offer them. They usually last 1-2 years and you basically go wherever you want, and spend time overseas or back at the home institution lecturing or acting as an attending. Schedules are very flexible, but it allows you decent pay, lots of time to research/learn about medicine in the 3rd world, and get real experience.

If you went the IM route, an ID fellowship would probably be most helpful since infection is still by far the highest cause of morbidity/mortality overseas.

 

[NEATOMD]

I can't say I know much about the organizations Doctors without Borders or Mercy Ships, but I do know alot about medical missions to third world countries. I've been going on them since I was 12 and involved with them before that. So, hopefully this will help...

Here's the dealio:
When to start: You don't have to even be a doctor to start working on medical missions. Start whenever you get a chance, it takes more than doctors to run a medical clinic in the US or anywhere else. The sooner you get experience with them, the better.

How to start: Start small, I don't recommend trying to leave the country for years at a time right away. If that's what you feel like you're supposed to do, then go for it. But, in my experience it's much better to start out going on short term mission trips. Most Doc's wait for the long term till they retire. They've got few bills and a bit of cash in their pockets.
Basically, the time span for short term trips will vary with the organization you are with and the location, but many are as short as one to two weeks. This is pretty convenient and many are able to stick something like this into their vacation time. (If you choose to do something like this, watch out that you don't burn yourself out, getting away and relaxing is important for doctors!) But, most doctors I know start out doing this kind of trip. Many medical students even find time for them either during their first and second year or after they take Step 1. The best part of these trips is that they don't interfere with your practice or schooling for the most part, and are relatively cheap. So, what's cheap you ask...Well, the most expensive part of most trips like this is going to be travel expenses aka: airfares. Typically runs about $500-1200 for trips to Central America. Most trips I've been on typically have cost me between $900-1500.

The money issue: So, how do I come up with that kind of money? Don't worry about it that much. It's definately a big (and important) consideration, but if you decide to go on a medical mission trip, there are usually plenty of people willing to help you out. Especially, if you have religious affiliations of any type. So, while I said that the trips I've been on cost between 900- 1500, I personally have never paid that much. Donations are a beautiful thing.

Donations: Like I said, donations are a beautiful thing. Even if you can't personally travel to a third world country right now, you can still help (Man I sound like one of those give me money commercials, but no I don't want money). Ask hospitals and medical clinics if they have medical supplies that they would be willing to donate to medical missions. Not only are these supplies much needed today, but this can give you connections that you may find useful when you do actually go on a trip.
So, what kinds of donations? Well, I'd try to stay away from expired resources, but speak with whatever mission organization you are wanting to work with and they'll probably give you a good idea. In my experience, it the simple things that are often hard to come by in third world countries. They need stuff like antimicrobials, vitamins, gloves, surgical staples etc. It tends to be pretty and frustrating to try and get high tech gadgets into third world countries. Even more basic things like toothbrushes and toothpaste and soap are commodities that many poor citizens of third world country have never had.
(Warning: getting onto soap box) It really gives you a reality check to see people fighting for something that we take for granted such as soap. Its true, as a matter of fact, more than once, when I've giving it out, the people have thought it was a candy and tried to eat it before we could explain what it was for. Everytime we hand out toothbrushes and toothpaste we have to do demonstrations to explain how to use it, because they've never seen it before.

OK, getting back on track now...
Family: If you start on short term trips, then it is most likely not going to adversely affect your family. On the contrary, doc's who's family's are involved with them seem to really enjoy the experiences and take alot from them.

Residencies: One of the best times to train for something like this might actually be while you are in school. Many schools allow for away clerkships during your 4th year. PERFECT OPPORTUNITY 👍

Aside from this, you can be used no matter what residency you choose. Primary care docs are really good at being able to go wherever, just show up and help out. I've even seen some go door to door. But, specialized docs more often go to organized brigades that treat patients who have been preselected for procedures. (IE, first and optometrist or ophthalmologist goes through an area and treats patients. Ones that need surgery will receive instructions to show up for a later brigade that will include an ophthalmic surgeon with equiptment.)

Final Notes:
Better to overprepare than to end up somewhere stranded and without supplies.

Befriend the people you work with. That includes the hired help such as translators and the locals.

Take time to be a normal person. Don't just see patients or you'll probably end up regretting the experience. Take time to talk to the locals outside of the clinic, kick a ball around with some kids, or hold a baby or two.

You'll probably feel guilty when you get back because you think you got more out of the experience than you could ever have given!

Watch out for depression. Many people experiences some form of the blues right after they get back from trips. Confront the problem and talk about it with others.

One more thing: Don't drink the water, seriously, don't do it.

 

[Rafa]

I love this thread already.

 

[LINEski]

EM, IM, or FP would be most ideal... If you went the EM route, an International Medicine fellowship would be perfect for you. They are not boarded fellowships, but lots of EM programs offer them. They usually last 1-2 years and you basically go wherever you want, and spend time overseas or back at the home institution lecturing or acting as an attending. Schedules are very flexible, but it allows you decent pay, lots of time to research/learn about medicine in the 3rd world, and get real experience.

If you went the IM route, an ID fellowship would probably be most helpful since infection is still by far the highest cause of morbidity/mortality overseas.

What do you mean when you say "they are not boarded fellowships"? Can you do a tropical medicine or an infectious disease fellowship after EM residency or just after IM residency?

 

[Ypo.]

I know that Doctor's Without Borders does not let you take a spouse or family along. I read that on their website. I emailed them and specifically asked if there were exceptions but they never emailed back.

But there are lots of other opportunities around. I don't think you need to have prior international experience for the vast majority of them.

 

[Guevara M.D.]

Oh my god...so many responses so quick...thanks guys. Y'all are the ****.

But what about the World Health Organization? Does anyone know anything about them? Do they seek out doctors? If so what do those doctors do? I would love to meet some doctors who have done international work...hope to do so this fall.

 

[garyinthehouse]

Oh my god...so many responses so quick...thanks guys. Y'all are the ****.

But what about the World Health Organization? Does anyone know anything about them? Do they seek out doctors? If so what do those doctors do? I would love to meet some doctors who have done international work...hope to do so this fall.

Sorry to revive an old thread...

I am interested in the World Health Organization as well. Do they hire doctors are paper pushers, or are the active in the international medical community? Does anyone know anything about doctors in the WHO?

Thanks!

 

[Mr hawkings]

Sorry to revive an old thread...

I am interested in the World Health Organization as well. Do they hire doctors are paper pushers, or are the active in the international medical community? Does anyone know anything about doctors in the WHO?

Thanks!

Why dont you do to their website. Look at their employment page and see who they hire.

In my limited experience, they rely on local medical personel and philanthropic medical organizations and they just provide the administrative and logistical support. This may be different in places with fewer local docs. I dont know.

 

[FlaMedic]

Read this book or check it out from the library...

http://www.amazon.com/Hope-Hell-Doc...bs_sr_1?ie=UTF8&s=books&qid=1238381076&sr=8-1

Don't expect to be thrilled with MSF if your looking to save little african babies or something.

The volunteers with MSF don't even practice medicine in reality. They are more into training local "doctors". Which as I understand frequently tends to be "medicine man" types.

Also if you have student loans to payback, don't just expect your lender to accept MSF's letter for deferral. Most lenders will say..."uh, no you can keep paying, but thanks for asking". Maybe if you were in a federal consolidation program they might.

Ive heard a lot of doc's have not been wholly fulfilled by their experience with them. Just what I have read......