doctors without borders

[Munir]

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It will be fun to really jump in the field and save some lives.

Has any one worked with Doctors without borders? Or any similar organization?

I want to spend atleast one elective month during my residency working in the field.

Any ideas?

 

[DarthNeurology]

It will be fun to really jump in the field and save some lives.

Has any one worked with Doctors without borders? Or any similar organization?

I want to spend atleast one elective month during my residency working in the field.

Any ideas?

I am pretty sure doctors without borders wants physicians who are 2-3 years out of residency, i.e. they don't take resident doctors in training as they don't have time to train you in the situations they go to. You will have to setup an elective with a foreign doctor in the country of your choice to supervise you.

 

[Danbo1957]

DarthNeurology is correct.

I did a six month tour with Doctors Without Borders in Africa in 1996 - consider it pro bono. As a life experience, and a medical challenge, it was worth doing.

 

[Winged Scapula]

The above is correct. They want attending physicians and I believe the min time commitment is 3 months. Some residency programs allow some time abroad but you have to make sure the training meets ACGME and board requirements.

 

[DarthNeurology]

The above is correct. They want attending physicians and I believe the min time commitment is 3 months. Some residency programs allow some time abroad but you have to make sure the training meets ACGME and board requirements.

From MSF Website:

Basic requirements for joining MSF in the field:

• At least two years of professional experience
• Physicians: Availability for a minimum of six months (with the exception of surgeons and anesthesiologists, who may be accepted for shorter assignments)
• All other professions: Availability for a minimum of 6 to 12 months, with preference for those available for 9 to 12 months
• Flexibility
• No recent gap in clinical experience greater than two years
• Language skills are considered a major asset
• Relevant travel or work outside the United States

I think for most residency programs you can do some global health work abroad, but you usually have to do it during elective time so it doesn't cut into ward or clinic months, i.e. real clinical training time.

 

[AmoryBlaine]

It will be fun to really jump in the field and save some lives.

Has any one worked with Doctors without borders? Or any similar organization?

I want to spend atleast one elective month during my residency working in the field.

Any ideas?

All posts above correct to bring up requirements to work with DWB/MSF. Not to jump on one word in your post but I'm not sure that most MSF volunteers would describe their work as "fun."

 

[McGillGrad]

They are in dire need of Francophones, although I am not looking forward to being the white Canadian in Haiti or Cote d'Ivoire. Why can't I use my French to help the needy people of Monaco...🙂

 

[LADoc00]

Doctors without borders like modern Christianity in general has a deluded impression they are doing good work, they most definitely are not.

They are enabling corrupt and murderous regimes to stay in power both in Africa and Latin America by placating the masses with random positive reinforcement.

Most of the time Doctors Without Borders serves a spiritual remedy for shallow docs who are brazen SOBs to their colleagues and patients back in their country of origin. The brimming self righteousness is quite amusing to me.

Let me break it down: What you do DOESNT matter, at all. And no one cares, least of which the village people you are treating with your self righteous neo-Colonial hautiness.

 

[DarthNeurology]

I don't know about that, all of the doc sans borders I've met are pretty nice people, you assume that if MSF didn't treat a couple thousand people during a health crisis that people would rise up and overthrow the dictators, trouble is that sick people don't make good commandos.

This argument that organizations like MSF prop up dictator regimes is an old one that rears its head on the internet from time to time, (I first hear this theory many years ago) mostly by people who are threatened by doctors who are more optimistic and into service practices than they are. I think doctors without borders helps as it draw intranational and international attention to atrocities occurring in a nation. People will still rebel against dictators if their families/friends are killed in great enough numbers.

 

[LadyGrey]

I'm also not sure what "modern Christianity" has to do with it, LADoc00. MSF is a totally secular organization. Their lack of missionary agenda is one of the things I respect and admire.

 

[McGillGrad]

I believe that he was being figurative, in the sense that we physicians sacrifice (money and material comforts) to attain a higher moral ground within our souls by donating our time and skills to MSF. Much in the way that Christian missionaries sacrifice and take risks to convert non-Christians.

I'm also not sure what "modern Christianity" has to do with it, LADoc00. MSF is a totally secular organization. Their lack of missionary agenda is one of the things I respect and admire.

 

[Danbo1957]

Please. Volunteer work in any setting is its own thing - motives are irrelevant. Healing someone's toothache is healing someone's toothache.

As far as "corrupt and murderous regimes": so are the Western governments.

 

[drfunktacular]

Doctors without borders like modern Christianity in general has a deluded impression they are doing good work, they most definitely are not.

They are enabling corrupt and murderous regimes to stay in power both in Africa and Latin America by placating the masses with random positive reinforcement.

Most of the time Doctors Without Borders serves a spiritual remedy for shallow docs who are brazen SOBs to their colleagues and patients back in their country of origin. The brimming self righteousness is quite amusing to me.

Let me break it down: What you do DOESNT matter, at all. And no one cares, least of which the village people you are treating with your self righteous neo-Colonial hautiness.

This brings to mind a section of Jonathan Kaplan's book The Dressing Station (amazon link). He's a South African surgeon who did many stints with MSF in places like Kurdistan during the first Iraq war:

"In my more lucid moments I wondered what I had achieved. After all, there were more effective ways to stop people dying than by being a surgeon. On my final helicopter flight I had sat next to a Swedish water engineer who told me about his work, while my body shook with chills. He built filtration plants, and the clean water that he had brought to the refugee camps had preserved probably thousands from death. By comparison I'd saved perhaps a handful of lives by operating to stop blood-loss or gangrene; improved the outcome of injuries in a few more cases where I was able to conserve a damaged limb or clean a wound, and possibly - just possibly - prevented some fatalities through the haphazard distribution of drugs among the refugees. In fact, I reflected, the most significant thing I did out there wasn't even medical." (He then tells the story of stealing a tent from the Turkish army to house a family)

My own personal opinion tends to be that if you really want to help the starving peoples of Sudan/Iraq/Congo/Bangladesh/everywhere else, medicine is probably not the best route. Go into politics (well, ok, probably not politics), policy-making, infrastructure engineering (as in this example), public health, epidemiology, vaccine development/distribution, aid/relief organization administration (although most of these tend to waste more money on bureaucracy than they expend on aid--my understanding is that MSF is a notable exception to this), etc etc. Being an orthopedist in Liberia or wherever is probably going to help a few people (at great, arguably unjustifiable, personal risk), but the odds are those people you help will starve to death, or get TB/HIV/meningitis/cholera/whatever, or be blown up by a land-mine, or be killed by a government militiaman because the environment and system they live in is so gummed up to begin with; having an extra doctor around isn't going to change that.

 

[drfunktacular]

As far as "corrupt and murderous regimes": so are the Western governments.

OH BURN

 

[BlondeDocteur]

Doctors without borders like modern Christianity in general has a deluded impression they are doing good work, they most definitely are not.

They are enabling corrupt and murderous regimes to stay in power both in Africa and Latin America by placating the masses with random positive reinforcement.

Most of the time Doctors Without Borders serves a spiritual remedy for shallow docs who are brazen SOBs to their colleagues and patients back in their country of origin. The brimming self righteousness is quite amusing to me.

Let me break it down: What you do DOESNT matter, at all. And no one cares, least of which the village people you are treating with your self righteous neo-Colonial hautiness.

Although a believer in the utility of international volunteer work, I STRONGLY agree with this. The majority of MSF volunteers-- particularly the so-called "lifers"-- are miserable human beings who both volunteer to attempt to give their lives some sense of purpose and who cop unbelievable holier-than-thou attitudes, even though their own lives are hardly studies in ascetic devotion.

Many volunteer for the passport stamps and the war stories, not even for misguided senses of altruism. Many are "medical tourists." As one of the above posters noted, the way to create long-standing change is through policy and big infrastructure projects, not by treating individual patients. (Though having been in such situations myself before getting clinical training, I can't tell you how frustrating it is to be in the thick of things working with NO medical knowledge and to be completely unable to help people in the short-term, even while investing in long-term change).

You might think I'm crazy or shallow or both, but the first time you see Western "aid workers" paying 13 year olds $3 for disgusting sexual services, or staying in the poshest hotel in the capital while driving out to the shantytowns each day and thinking *nothing* of the alternative uses their salaries could be put to, you'll agree. And the field work itself is much more sobering and frustrating than it is "fun." When you first treat a child dying from an easily preventable disease, or see your patients sell their medicines on the streets, you'll quickly realize that clinical medicine, with it's patient-by-patient basis, is really a "pissing in the ocean" approach.

 

[DarthNeurology]

. . . like modern Christianity in general has a deluded impression they are doing good work, they most definitely are not.

I have seen a lot of sincere missionaries doing really good work to help although I am not one of their religion, so I think a generalization like this is obviously false and the poster may also feel threatened by those of the Chrisitian faith, many of whom are doing things to help others. . . with a "Damascus Gate" location I think this person might be of another religion and is trying to knock down Christianity although it is hard to tell, we should all I have tolerance for other people's religions and even appreciate the positive things that others do even though they are a different religion . . . this person should know that organizations like MSF are non attempting to convert anybody

 

[RTrain]

...As one of the above posters noted, the way to create long-standing change is through policy and big infrastructure projects, not by treating individual patients. ...

While this is true, that does not mean that there is no merit in treating those individual patients. It is trite and cliche, to be sure, but it makes me think of the boy on the beach throwing starfish back into the ocean. You know, the man comes up to him and points out that there are thousands upon thousands of starfish on the beach, and his puny efforts do not matter; the boy throws out another starfish and says, "It matters to that one."

You are definitely right, the people who are habitual medical missionaries are often insufferable, self-aggrandizing jerks, but the works they do are still good works that make a difference, at least to the few people they do them for.

 

[Ypo.]

As someone who has been on several medical missions to impoverished countries, I can really relate to the "what good am I really doing here" feeling.

The first year I went on a mission, it felt great. I felt great. I thought we were helping people. Essentially we brought down clothes, food and provided health care to hundreds of people for 1 week.

The next year we went down with bigger plans: HIV education, training villagers as HIV/AIDS counselors, training villagers to become nurse aids, starting microbusinesses, expanding the orphanage, and putting in a water pipe to bring clean water to 80 families. But the whole time I was there, I felt horrible, because I was seeing the picture clearly. Contrary to the first year we were down there, I hated giving out "free stuff." All I could feel was that we were making them dependent on us for the sake of our own egos and not doing anything sustainable. The ONE good thing we did (that I feel good about) was putting in the water line. And believe me when I say, the teams I have went there with are WONDERFUL. There wasn't any colonialism in our attitudes. But the truth is that you go with a certain ideal picture, and what you get may be different. And what that ideal picture is can be so unrealistic to begin with.

That said, you can't be too self-deprecating or analytical, or you'll never help anyone. I'm going again this year, and my goals are more focused. I plan on doing an asthma community needs assessment (a big problem down there). I'd like to help a few people start some micro-businesses. We'd like to train people to provide some basic health care so that the people won't only depend on foreign teams of doctors coming in. I'd love to help the families living with HIV, but you can't help them unless they want it. Our organization is too small to support them. When I was there, I saw despair, but I also saw people looking only for a handout. Hopefully we will find a few people who have good business ideas that we can help.

I don't lie to myself. The reason that I am attracted to international medicine as opposed to just volunteering locally is for the excitement of meeting a new people and seeing a new land, and perhaps learning a new language. I also volunteer locally, but it's just not as exciting.
Another observation; there is a different feeling to helping people who want to be helped and helping people who just want to use you/get handouts. I'm sure we've all felt the difference with those patients who are just trying to get vicodin out of you rather than do anything for their health. It has been my experience that the proportion of people wanting to be helped and willing to make an effort versus those just looking for handouts is higher in impoverished countries. I admit I don't want to waste my time on people who aren't trying to help themselves as well.

I've considered doing MSF as well. But I am incredibly leery after hearing some of the opinions on this board. I would appreciate more information about this.

 

[Ypo.]

You might think I'm crazy or shallow or both, but the first time you see Western "aid workers" paying 13 year olds $3 for disgusting sexual services, or staying in the poshest hotel in the capital while driving out to the shantytowns each day and thinking *nothing* of the alternative uses their salaries could be put to, you'll agree. And the field work itself is much more sobering and frustrating than it is "fun." When you first treat a child dying from an easily preventable disease, or see your patients sell their medicines on the streets, you'll quickly realize that clinical medicine, with it's patient-by-patient basis, is really a "pissing in the ocean" approach.

I was under the impression (from reading their website) that most of your time as a doctor would be spent training health care workers. Apparently you have volunteered with MSF, though. I would love to hear more of your experience.

 

[Ypo.]

Please. Volunteer work in any setting is its own thing - motives are irrelevant. Healing someone's toothache is healing someone's toothache.

I really like this attitude. 👍

 

[Doodledog]

Most SDN discussions about international work relate to pre-meds and med-students, this is an uncommon one discussing residency and beyond. I'd like to first say that I have no connection with MSF and can't comment on that group, their motivations or accomplishments. I can comment on the more general topic of residents, fellows, and attendings doing international medical work from many years of doing it and supervising it.

I certainly agree that it is best to be making grand political and economic changes to help people develop sustainable approaches to improving their health. However, the reality is that few American physicians have that type of connection with a foreign country/government and those who do generally have spent decades building up to that point. To indicate that only this type of work, or large public health projects is worth doing, is to, in my opinion, avoid doing anything. One is not obligated to get involved internationally, but to use dislike for one group, or belief that only national-scale projects are helpful, is not a fair reason to reject all projects.

It is also true that helping individuals, through small medical projects in tiny communities is frustrating, non-sustaining and can be seen, not incorrectly, as taking some of the responsibility away from the national government for providing these services. However, the overwhelming majority of such projects are done, in my experience, by very well meaning people and in areas that simply would not be served if they had not come. I am doubtful that the governments would or could take over these clinics, etc if the Americans and other Westerners left. As such, the treating of an individual, especially a child who cannot do much for themselves has a lot of intrinsic value and is unlikely to set back political, social or medical development. I can't speak for every community, but I have substantial doubts that most of the people assisted in these projects dislike the helpers. In fact, rather than thinking of us as colonialists, I believe the usual thought is that they believe we should be doing MORE to help them. But of course, YMMV.

However, just separating projects into big nationwide interventions and tiny individual ones denies the middle ground which I think is a growing and important one. The middle ground consists of development programs and partnerships between US institutions (or large groups) and foreign institutions. There are other such models, but, this is an important one. In this model, institutions commit to capacity building and training in ways that the local government could not. For example, Harvard AIDS and similar programs involve fully-supported, sustainable training and care programs. There are larger and smaller such programs covering a range of conditions, institutions, etc in existence. Many focus on local capacity building.

So, whether you are interested in MSF or not, there are multiple opportunities to participate both during residency and as an attending in projects that have some sustainable component.

 

[DarthNeurology]

Most SDN discussions about international work relate to pre-meds and med-students, this is an uncommon one discussing residency and beyond. I'd like to first say that I have no connection with MSF and can't comment on that group, their motivations or accomplishments. I can comment on the more general topic of residents, fellows, and attendings doing international medical work from many years of doing it and supervising it.

I certainly agree that it is best to be making grand political and economic changes to help people develop sustainable approaches to improving their health. However, the reality is that few American physicians have that type of connection with a foreign country/government and those who do generally have spent decades building up to that point. To indicate that only this type of work, or large public health projects is worth doing, is to, in my opinion, avoid doing anything. One is not obligated to get involved internationally, but to use dislike for one group, or belief that only national-scale projects are helpful, is not a fair reason to reject all projects.

It is also true that helping individuals, through small medical projects in tiny communities is frustrating, non-sustaining and can be seen, not incorrectly, as taking some of the responsibility away from the national government for providing these services. However, the overwhelming majority of such projects are done, in my experience, by very well meaning people and in areas that simply would not be served if they had not come. I am doubtful that the governments would or could take over these clinics, etc if the Americans and other Westerners left. As such, the treating of an individual, especially a child who cannot do much for themselves has a lot of intrinsic value and is unlikely to set back political, social or medical development. I can't speak for every community, but I have substantial doubts that most of the people assisted in these projects dislike the helpers. In fact, rather than thinking of us as colonialists, I believe the usual thought is that they believe we should be doing MORE to help them. But of course, YMMV.

However, just separating projects into big nationwide interventions and tiny individual ones denies the middle ground which I think is a growing and important one. The middle ground consists of development programs and partnerships between US institutions (or large groups) and foreign institutions. There are other such models, but, this is an important one. In this model, institutions commit to capacity building and training in ways that the local government could not. For example, Harvard AIDS and similar programs involve fully-supported, sustainable training and care programs. There are larger and smaller such programs covering a range of conditions, institutions, etc in existence. Many focus on local capacity building.

So, whether you are interested in MSF or not, there are multiple opportunities to participate both during residency and as an attending in projects that have some sustainable component.

A big deal is made about working on a project and going back to the same place every year, i.e. academic medicine types look down on students 🙂eek🙂 who move from country to country doing single time projects, but in reality I think both types of projects are good, such as for example helping out in a time of natural disaster. Some attendings have done global health projects in multiple countries, who to say that that is not helping people any less than work on a "sustainable" project. I think are plenty of organizations like MSF that are sustainable by themselves, and while different attendings rotate through them that is OK. Helping people on a one to one basis is what doctors do regardless of whether in a developing country or the US, so we shouldn't be deluded to believe that this is only "pissing in the ocean" otherwise ALL of medicine is pissing in the ocean, . . .

 

[BlondeDocteur]

As I said, I believe fully in the utility of international medical volunteer work. The ideal approach would be to both treat the patient and the context-- I know that's the principal motivation that drove me into medical school, out of global health.

MSF is a strictly clinical field placement for MDs and RNs. You do not spend most of your time abroad training community health workers or the like-- though arguably you would wish to leave some sort of footprint after you leave, so training people to take over is a common goal. Many people in the non-surgical fields feel that there are strong ethical dilemmas re: short-term work. What's the utility of zipping in, treating acute exacerbations of chronic conditions, or fixing up a case of an infectious disease, only to leave without continuity care, or a way to ensure patients will still be able to receive meds 6 months from now? The surgical people are less bothered by this, both for reasons of temperament and also because a surgical operation is viewed as being more definitive than a clinic visit.

I think MSF unfortunately suffers from its fame and reputation. Since it's probably the one I-NGO with general layperson cache, a lot of egos are attracted towards it. You might think I'm joking, but I honestly believe for a lot of (male) doctors, saying "I volunteer with MSF" in a bar is about 40% of their motivation-- particularly if the listener is a young, nubile, impressionable girl. Other people have automatically assumed it's "the best" and volunteer for resume purposes (again, I wish I were kidding, but I'm not). Both types make miserable, ineffective field workers who do much to sully the name of MSF and of their respective countries.

By all means, please volunteer to go abroad! These communities need desperate help. But recognize that the problems are as intractable as any in the US. If you have visions of The Great White Hope dashing in to the jungle to set things aright (and many people, though not conscious of such things, are actually motivated like that)-- prepare to be disappointed. Likewise, if you've commonly found yourself frustrated in the US by the medicine patients who won't take their meds, or the drug seekers, or those who continue to smoke and overeat and drink despite medical advice-- you'll find local variants of that abroad. And many people, after a couple of weeks working in a clinic encountering individual patients whose diseases are symptoms of an underlying cause begin to work to address those causes. Quite quickly you might find that creating a community marketing program for bednets is a more exciting and fulfilling way to spend your time versus diagnosing yet another pediatric malaria case, as hard as that seems to believe over here.

 

[AmoryBlaine]

Fantastic discussion and suprisingly respectful! Kudos to all.

After one "international experience" I was left with a completely disgusting taste in my mouth. It seemed like every other medical student was all about "reflecting" and having these quasi-magical experiences. I always wanted to be like, "sure, that little girl is really cute but there's a decent chance she'll die of a diarrheal illness right about the time you're sipping an $8 Martini in an upscale lounge back home."

Fact is that I think if the question were ever well-studied we would find out that most of us would do a lot more good sending the price of our air-fare to OxFam or some other such worthy organization.

 

[DarthNeurology]

Many people in the non-surgical fields feel that there are strong ethical dilemmas re: short-term work. What's the utility of zipping in, treating acute exacerbations of chronic conditions, or fixing up a case of an infectious disease, only to leave without continuity care, or a way to ensure patients will still be able to receive meds 6 months from now? The surgical people are less bothered by this, both for reasons of temperament and also because a surgical operation is viewed as being more definitive than a clinic visit.

You might think I'm joking, but I honestly believe for a lot of (male) doctors, saying "I volunteer with MSF" in a bar is about 40% of their motivation-- particularly if the listener is a young, nubile, impressionable girl.

I think that is pretty cynical as most male MSF doctors already have a significant other, many are married in stable relationships, also, doctors who go to do MSF projects actually leave behind a lot of the comforts of the US, . . . I can't think of any guy doing this sort of thing just to impress a lil 'ol girl in a bar. I have felt that female physicians who talk about international health, maybe aren't really in the field, don't take male medical students as seriously as perhaps a female medical student when both want to say work with HIV+ kids in Africa, so I wouldn't advocate propagating this sort of sentiment, ALL help is sorely needed abroad, obviously you don't get the follow up as in the U.S. but given a choice between no care and some care I know which I would choose if I were a citizen in a developing country. I think you grossly are misinterpreting the motivations of others who work for MSF. . .

 

[Tired]

Fantastic discussion and suprisingly respectful! Kudos to all.

If poor people need doctors, why don't they just get jobs and hire one?

 

[AmoryBlaine]

If poor people need doctors, why don't they just get jobs and hire one?

I don't get it.

 

[Tired]

I don't get it.

It just seems like providing medical care in 3rd world children only exacerbates the growing population problem.

 

[dnslay]

It just seems like providing medical care in 3rd world children only exacerbates the growing population problem.

Ow... my altruism 🙁

 

[McGillGrad]

It just seems like providing medical care in 3rd world children only exacerbates the growing population problem.

I used to think that way in the 8th grade.

Then I grew up.

 

[Tired]

I used to think that way in the 8th grade.

Too bad you had a doctor, otherwise you could have been in the 8th grade forever.

At least in everyones' memories . . .

 

[McGillGrad]

Weak reply, but you must just be 'tired', just like your comebacks....lol

Too bad you had a doctor, otherwise you could have been in the 8th grade forever.

At least in everyones' memories . . .

 

[AmoryBlaine]

It just seems like providing medical care in 3rd world children only exacerbates the growing population problem.

Now that you mention it the oxygen on this planet does seem to be getting a little thin these days...

I'll stop giving money to charity and see if that helps.

 

[BlondeDocteur]

II have felt that female physicians who talk about international health, maybe aren't really in the field, don't take male medical students as seriously as perhaps a female medical student when both want to say work with HIV+ kids in Africa,

I actually have found the opposite to be true. Most female docs would take a male med student more seriously as-- particularly in peds-- they project their own desires for stable family life onto female students. It seems like you had a poor experience on your peds rotation(s), so I do hope in the upcoming year you get to rotate in a different hospital. Most male students in our children's hospital are welcomed with open arms, in fact they're preferentially recruited.

My $0.02 is that if you're seriously about clinically practicing overseas, med-peds is definitely the way to go.

And work abroad... I've been a consultant for private NGOs, for country governments, for Ministries of Health, and worked in solo clinics. I can assure you that many aid workers are desperately seeking a sense of purpose in their lives, have recast themselves as secular missionaries, and often find solace in the arms of underage girls.

 

[LADoc00]

To add more, to "resume hound" premeds and med students who think for some strange reason doing this crap will increase your chances of fellowships or jobs...you couldnt be more wrong. Seriously. And looking at most of you on this board that is your no1 motivation.

How crappy must it really feel to be a premed, go to Africa and see people suffering right and left all the while you entertain fantasies of Harvard Med and spend evening flirting with other narcissistic premeds.

Times change, this crap never does.

 

[LADoc00]

I'm also not sure what "modern Christianity" has to do with it, LADoc00. MSF is a totally secular organization. Their lack of missionary agenda is one of the things I respect and admire.

reread my post. Reading comprehension FTW.

These B.S. medical aid groups LIKE (as in SIMILIAR fashion) to modern Christianity go to third world countries and pretend they are doing good to assuage their guilt and further their own insidious purposes. Kinda like a "spiritual" version of the DeBeers Diamond Mining Corp.

An analogy (another vocab word!) would be someone who rationalizes they can offset molesting the next door neighbor's kid if they drive a hybrid car.

Often, said individuals enjoy the smell of their own farts, because their extreme self righteousness alters their olfactory senses.

 

[Ypo.]

I was still hoping that people would post some of their direct experiences about international volunteering. I've heard a lot of bashing of people who want to do international work and of MSF, but how I can't tell how much of this is just uninformed opinion as opposed to actual experience?

 

[BlondeDocteur]

I posted a bit about this in the surgery forum, but I'm happy to share my experience. I'm an MS3 right now who reluctantly came to clinical medicine after getting a career going in global health. I've worked in Africa, Asia and the Caribbean. I've been a consultant for a US I-NGO, running a field study for them in a couple of different country sites. I've been a consultant for country governments and Ministries of Health. I've worked on infectious disease epidemics (mainly malaria), I've mapped villages, rivers and cases. I've worked in stand-alone clinics, seeing patients with tropical diseases, doing first aid, delivering babies, the whole nine yards-- without an MD. I hold an advanced degree in tropical medicine, and in addition to all of this-- which was strictly WORK-- I've travelled very extensively... six continents and counting. 🙂

While at med school in New York I've been plugged into the NGO scene here (working with, amongst others, MSF). I've also been president of the international health student group. This has mainly meant that I've been begging overprivileged Ivy-educated students to bang about Africa for a bit. This has been troubling because the majority of the time, students go abroad to resume build/passport stamp collect/ "practice" on international patients. My hope is that one or two of them will see something there and be moved to the degree that 20 years down the line, when they're wealthy dermatologists and orthopedic surgeons, they'll write some checks, advocate for some causes, support some policies, or-- if they must-- volunteer on missions.

So I like to consider myself "the real deal" when it comes to international health. But, as much as he is cynical and perhaps a wee bit trollish, I do find myself agreeing with LADoc, for reasons posted above.

 

[Ypo.]

I've worked in stand-alone clinics, seeing patients with tropical diseases, doing first aid, delivering babies, the whole nine yards-- without an MD. I hold an advanced degree in tropical medicine

That is quite impressive and certainly lends a lot of weight to your opinion. You must know a lot of people in the global health circle. Are there organizations that you were more impressed by than MSF? I'd like to volunteer in the future but I would prefer to avoid all the egos previously mentioned.

If you don't mind sharing, I'm curious, what "advanced degree" do you have? (Apparently it's clinical?) I was under the impression that MSF did not accept PAs. What made you decide to go to medical school after you were already doing all that?

 

[BlondeDocteur]

At the risk of making myself more google-able, I'll say it's a degree not attainable in the United States, it's only quasi-clinical, and it's an entree into global health. Sort of like a super-MPH, but focused on tropical medicine.

Although I believed very strongly in the work I was doing-- addressing the roots of health problems-- it was very frustrating not to be able to act in the here-and-now. When, for example, I was in Uganda working on a malaria epidemic that was decimating the children there, parents heard there was a 'doctor' in the village and would walk miles to see me. All I could say was "sorry, go to the clinic 12 miles down the road..." the clinic with no medicines, no staff, and high fees. That was more than enough to drive me to get an MD.

There's a long list of NGOs accepting medical volunteers here:
http://www.imva.org/Pages/orgdb/wblstfrm.htm

In my own experience I have been EXTREMELY impressed with World Vision, and with the International Rescue Committee.

Incidentally, Ypo, there is a strong need for international mental health services. You can easily nurture your interest in psychiatry with your desire to work in global health. You'll have to google a bit to find someone, usually a faculty member with joint appointments in a school of public health and a psych department, who might accept students to go abroad. MSF accepts mental health volunteers-- again, for long-term placement. And most of the disaster relief/ forced migration NGOs have psychiatrists and psychologists to deal with the trauma these populations incur.

 

[nattygann01]

They are in dire need of Francophones, although I am not looking forward to being the white Canadian in Haiti or Cote d'Ivoire. Why can't I use my French to help the needy people of Monaco...🙂

If that's how you feel, there is no need for you in those countries. It's better not to go if you are gonna go with that attitude...

 

[Ypo.]

At the risk of making myself more google-able, I'll say it's a degree not attainable in the United States, it's only quasi-clinical, and it's an entree into global health. Sort of like a super-MPH, but focused on tropical medicine.

Although I believed very strongly in the work I was doing-- addressing the roots of health problems-- it was very frustrating not to be able to act in the here-and-now. When, for example, I was in Uganda working on a malaria epidemic that was decimating the children there, parents heard there was a 'doctor' in the village and would walk miles to see me. All I could say was "sorry, go to the clinic 12 miles down the road..." the clinic with no medicines, no staff, and high fees. That was more than enough to drive me to get an MD.

There's a long list of NGOs accepting medical volunteers here:
http://www.imva.org/Pages/orgdb/wblstfrm.htm

In my own experience I have been EXTREMELY impressed with World Vision, and with the International Rescue Committee.

Incidentally, Ypo, there is a strong need for international mental health services. You can easily nurture your interest in psychiatry with your desire to work in global health. You'll have to google a bit to find someone, usually a faculty member with joint appointments in a school of public health and a psych department, who might accept students to go abroad. MSF accepts mental health volunteers-- again, for long-term placement. And most of the disaster relief/ forced migration NGOs have psychiatrists and psychologists to deal with the trauma these populations incur.

Oh, I'm not going into psychiatry! I was just posting in that forum because I'm on my psych rotation right now. (But I am going into primary care).
I've been lucky enough to find a site in Latin America where I can establish an ongoing project. I've been there twice in the past two years, will go again this fall and once again before residency starts. I'm hoping to do a needs assessment this fall and then apply that info when I return.

But thanks so much for sharing your information. I will definitely check out the two organizations you've mentioned. The experiences you have talked about sound incredible. That's very interesting how you talk about being frustrated about not being able to act in the here and now. It sounds like what you were doing would have a long term impact, but I understand what you mean. Sometimes I feel like what we do medically is only a drop in the bucket. I have been frustrated about not being able to do enough in the here and now as well.

Good luck with the rest of your schooling. Maybe we'll meet up on a different continent one day. 👍

 

[DarthNeurology]

. . . med students who think for some strange reason doing this crap will increase your chances of fellowships or jobs...you couldnt be more wrong. Seriously. And looking at most of you on this board that is your no1 motivation.

How crappy must it really feel to be a premed, go to Africa and see people suffering right and left all the while you entertain fantasies of Harvard Med and spend evening flirting with other narcissistic premeds.

Times change, this crap never does.

No, I know that it will be a deficit to my "career" i.e. Americanized version of making it big in medicine to do tours with MSF, i.e. 2-3 years here and there, while colleagues back home are putting in time becoming more senior attendings, doing research, etc . . . No one who seriously considers doing this stuff thinks otherwise, in fact people doing international work should perhaps get some support to offset the losses (not likely) as more people would be able to do it then! Yeah, . . . I would gladly work in an underserved area in the U.S. too but I think people abroad need more help . . . trust me, the big decisions are never about money.

 

[DarthNeurology]

reread my post. Reading comprehension FTW.

These B.S. medical aid groups LIKE (as in SIMILIAR fashion) to modern Christianity go to third world countries and pretend they are doing good to assuage their guilt

There are many faith based groups that do go to the underserved world and do help people in major ways. However, these are not the people who really run the world who's decisions affect millions, who have agendas, and who you wouldn't recognize if you walked down the street, you obviously have no grip on realty if you think Christianity has an insidious agenda compared to many other groups I could but won't name that you have probably never heard of. Christianity has changed significantly from the days of the Crusades in fundamental ways, and while helping a lot of people one-on-one, go look at how many people are educated world wide by them, they have lost power/influence on the world stage and while being made a target for various conspiracies are not worthy of the name "conspiracy" as this point in time. I can name 5 organizations out there that if you knew what they are doing it would pale by comparision to what "do-gooders" are doing. Christianity obviously makes you very uncomfortable/nervous, something that would be interesting to explore . . .

 

[8744]

My wife and I talked about me doing some medical volunteer work overseas with the Greek Orthodox Church after I finish residency but we decided against it because:

1. I don't want to live in a third world country and I have very little desire to travel outside the United States.

2. For the time I gave up, it would make more sense to stay at home, work, and give the money to the Church to use to pay local doctors or do with it whatever they felt necessary.

 

[DarthNeurology]

My wife and I talked about me doing some medical volunteer work overseas with the Greek Orthodox Church after I finish residency but we decided against it because:

1. I don't want to live in a third world country and I have very little desire to travel outside the United States.

2. For the time I gave up, it would make more sense to stay at home, work, and give the money to the Church to use to pay local doctors or do with it whatever they felt necessary.

Wow, I haven't met many people who didn't want to travel outside the U.S., I have been to multiple countries outside the U.S. and enjoyed each of them including the developing ones. Returning to the U.S. is always culture shock in reverse, you see how commercialized everything is in the U.S. and how the pace of life is different in the U.S. As for Number 2, most people probably wouldn't contribute the money earned during staying at home, and also they are short doctors abroad there is no doctor to pay to go to some underserved area . . .

 

[DarthNeurology]

I actually have found the opposite to be true. Most female docs would take a male med student more seriously as-- particularly in peds-- they project their own desires for stable family life onto female students. It seems like you had a poor experience on your peds rotation(s), so I do hope in the upcoming year you get to rotate in a different hospital. Most male students in our children's hospital are welcomed with open arms, in fact they're preferentially recruited.

I have found that my female pediatric attendings have been pretty good to work with, the worst attendings I worked with were male who didn't take to another male wanting to do pediatrics maybe. I have heard bad experiences with people who have MPHs but haven't been in the field. I can see people who are just "aid workers" soliciting inappropriate acts from minors, but I believe beyond a shadow of a doubt that 99.9% of doctors on such missions wouldn't do such a thing. I have *heard* about aid groups getting kicked out of countries for such reasons, but haven't heard that there was any truth to it, . . . I think that there is a lot of doubting of other people's motives in IH, partly because people don't want to acknowledge that we all have humanitarian traits and want to think of themselves as special, and partly because US doctors are overly cynical to the point of it being a sport. Thanks for the good links though.

 

[liposuction]

I'll add my voice to the chorus saying medical volunteering in 3rd world countries is at best a misguided and at worst simply a self-aggrandizing ego exercise. A poor country's biggest problem is that they're poor. Nothing cures poverty like wealth. There was an excellent recent NY Times article: "Can the Cellphone Help End Global Poverty?" It's a lengthy article but the core argument is pretty simple. Excerpted:

Jan Chipchase and his user-research colleagues at Nokia can rattle off example upon example of the cellphone’s ability to increase people’s productivity and well-being, mostly because of the simple fact that they can be reached. There’s the live-in housekeeper in China who was more or less an indentured servant until she got a cellphone so that new customers could call and book her services. Or the porter who spent his days hanging around outside of department stores and construction sites hoping to be hired to carry other people’s loads but now, with a cellphone, can go only where the jobs are. Having a call-back number, Chipchase likes to say, is having a fixed identity point, which, inside of populations that are constantly on the move — displaced by war, floods, drought or faltering economies — can be immensely valuable both as a means of keeping in touch with home communities and as a business tool. Over several years, his research team has spoken to rickshaw drivers, prostitutes, shopkeepers, day laborers and farmers, and all of them say more or less the same thing: their income gets a big boost when they have access to a cellphone.

It may sound like corporate jingoism, but this sort of economic promise has also caught the eye of development specialists and business scholars around the world. Robert Jensen, an economics professor at Harvard University, tracked fishermen off the coast of Kerala in southern India, finding that when they invested in cellphones and started using them to call around to prospective buyers before they’d even got their catch to shore, their profits went up by an average of 8 percent while consumer prices in the local marketplace went down by 4 percent. A 2005 London Business School study extrapolated the effect even further, concluding that for every additional 10 mobile phones per 100 people, a country’s G.D.P. rises 0.5 percent.
...Public health workers in South Africa now send text messages to tuberculosis patients with reminders to take their medication. In Kenya, people can use S.M.S. to ask anonymous questions about culturally taboo subjects like AIDS, breast cancer and sexually transmitted diseases, receiving prompt answers from health experts for no charge.
Some of the mobile phone’s biggest boosters are those who believe that pumping international aid money into poor countries is less effective than encouraging economic growth through commerce, also called “inclusive capitalism.” A cellphone in the hands of an Indian fisherman who uses it to grow his business — which presumably gives him more resources to feed, clothe, educate and safeguard his family — represents a textbook case of bottom-up economic development, a way of empowering individuals by encouraging entrepreneurship as opposed to more traditional top-down approaches in which aid money must filter through a bureaucratic chain before reaching its beneficiaries, who by virtue of the process are rendered passive recipients.
For this reason, the cellphone has become a darling of the microfinance movement. After Muhammad Yunus, the Nobel-winning founder of Grameen Bank, began making microloans to women in poor countries so that they could buy revenue-producing assets like cows and goats, he was approached by a Bangladeshi expat living in the U.S. named Iqbal Quadir. Quadir posed a simple question to Yunus — If a woman can invest in a cow, why can’t she invest in a phone? — that led to the 1996 creation of Grameen Phone Ltd. and has since started the careers of more than 250,000 “phone ladies” in Bangladesh, which is considered one of the world’s poorest countries....The endeavor has not only revolutionized communications in Bangladesh but also has proved to be wildly profitable: Grameen Phone is now Bangladesh’s largest telecom provider, with annual revenues of about $1 billion. Similar village-phone programs have sprung up in Rwanda, Uganda, Cameroon and Indonesia, among other places. “Poor countries are poor because they are wasting their resources,” says Quadir, who is now the director of the Legatum Center for Development and Entrepreneurship at M.I.T. “One resource is time, another is opportunity. Let’s say you can walk over to five people who live in your immediate vicinity, that’s one thing. But if you’re connected to one million people, your possibilities are endless.”​

This is not to say that as individuals there is nothing we can do. Instead of hanging out for six months in some poor tropical clinic, go to those places and help the people get connected to the global economy and be competitive in it -- teach them English, teach them to use computers, help them start and run a business, buy them cellphones 😉. Of course, a US trained, board certified MD may not be the best person to be doing the aforementioned activities -- a better use of your time would be to stay home, make lots of money off all the fat a$$ Americans who insist on continually making poor lifestyle choices and then send that money to people and organizations doing those things over there. Given the resources they’re perfectly capable of training their own doctors.

 

[BlondeDocteur]

My wife and I talked about me doing some medical volunteer work overseas with the Greek Orthodox Church after I finish residency but we decided against it because:

1. I don't want to live in a third world country and I have very little desire to travel outside the United States.

2. For the time I gave up, it would make more sense to stay at home, work, and give the money to the Church to use to pay local doctors or do with it whatever they felt necessary.

Hi Panda-- There are some nice overseas opportunities with IOCC (International Orthodox Christian Charities)-- including places like Greece, Lebanon, Palestine, Bulgaria, etc, which are less 'taxing' locales. Though I think reason #2 is solid and quite possibly the most sensible of all.

 

[LADoc00]

My wife and I talked about me doing some medical volunteer work overseas with the Greek Orthodox Church after I finish residency but we decided against it because:

1. I don't want to live in a third world country and I have very little desire to travel outside the United States.

2. For the time I gave up, it would make more sense to stay at home, work, and give the money to the Church to use to pay local doctors or do with it whatever they felt necessary.

OMG, we have a poster with common sense, a rarity in SDN!