EM and Missionary Medicine

[GreatSaphenous]

I am a MSIII planning on going into full time mission work. I was hoping to get your impression on which specialty would best enable me to be effective in the third world. Right now I'm torn between surgery and EM.

Any thoughts?


I am the Great Saphenous!


"He is no fool who gives what he cannot keep to gain what he cannot lose."
Jim Elliot

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[FoughtFyr]

I am a MSIII planning on going into full time mission work. I was hoping to get your impression on which specialty would best enable me to be effective in the third world. Right now I'm torn between surgery and EM.

Any thoughts?


I am the Great Saphenous!


"He is no fool who gives what he cannot keep to gain what he cannot lose."
Jim Elliot

I can't believe I'm saying this but...
I would suggest FP and would try for an unopposed residency (no other residency programs at the hospital) with a good deal of OB (preferably including c-sections). The Indiana University programs in Northern Indiana come to mind as do a few around Milwaukee, WI. I'm sure there are others. This would let you learn minor surgery, general medicine, OB, peds, a touch of EM, and a little psych. Given that most mission locations have no healthcare, I would think you would need a longer term emphasis than EM would give.

- H

 

[Aloha Kid]

Choose a career path that most interests you. Internship year and medical school prepares you well enough with the fundamentals to learn basic all around medicine when you get out.

If you truly love something like urology, there are always tons of third world country kids running around with hypospadias. If you want to be a ENT, then there will be a multitude of cleft lip surgeries out there as well. You get my point. It doesn't matter what kind of doctor you are. There is always a need. Just don't become a pathologist or a psychiatrist.

 

[ERMudPhud]

I've known a few missionary physicians and the most useful ones had a background in general surgery but trained in times and places where general surgeons still learned a fair amount of ortho and could do c-sections. Failing that an FP program that gives a good surgery experience might be the best.

 

[beyond all hope]

If you want to practice in a third world, with little or no resources, hundreds of patients per day, and nothing but your clinical judgement and a little luck to guide you, your best training would be in EM.

The only drawback to EM is you wouldn't actually be trained to do surgery.

 

[*Wing of Zock*]

Go for EM!

I think EM will give you the proper mindset to work in a third world situation. A lot of what you do in the field there (so I'm told) you wouldn't learn in any specialty because you don't have the same resources. (besides, didn't you see ER when Dr. Carter was there?).

I know a couple of programs I interviewed at had third world electives, which would be nice to see if that's really what you wanted to do. Specifically St. Vincents in Toledo and Allegheny in Pittsburgh.

good luck, You've got more B@lls than me.

 

[Wahoo]

In addition, if you do EM there are quite a few fellowships in "international emergency medicine" available, at programs like Hopkins, GWU, Keck/USC, etc. I'm not certain how useful these would be to your particular goal, but it seems like it would be worth looking into.

For a list of these fellowships see:
http://www.saem.org/services/fellowsh.htm#inter

 

[obecalp]

Hey guys, do you think that it would be difficult for an EM trained physician to learn how to manage chronically ill patients on the field like an IM/FP doc would?

 

[FoughtFyr]

Hey guys, do you think that it would be difficult for an EM trained physician to learn how to manage chronically ill patients on the field like an IM/FP doc would?

Not that hard, but if you know that mission work is your calling, it would seem to me that you might expect more "basic medicine" than critically injured/ill patients. As a kind of "professional triage", I've always assumed that an FP could do the most for the greatest number of people in a third world type situation. There are times that an EP would be "more handy", and a surgeon would really be nice at times as well, but FP would, IMHO, be the best suited.

- H

 

[NinerNiner999]

I don't think it would be difficult for am EM to learn preventive medicine (which is basically what you are asking), but I am not aware of any type of accredited preventive medicine fellowship or training path that would give this training (except for maybe a combined EM/IM program). Even the combined program, though, would fall short of prenatal care.

Of course, if you plan on practicing medicine in another country, It may be possible to do so after an internship and passing Step III (i.e. becoming licensed as a general practitioner), of course this would not allow you to practice much in the United States. An MD from the United States is looked at in high regard in many other countries and, if you are in a third world country, may be as good as gold.

Be careful though. I know a guy who worked in the Congo as a missionary from the ER. One of his friends joined him there and there was a rebel uprising near the village where he worked. His friend left before things turned south. Eventually, the rebels moved into the village and took him hostage and held him at gunpoint. His friend went back to find him and thought he was dead. It turns out the rebels thought he was a priest and spared his life. Oh wait - that was on ER. Never mind...

 

[Homunculus]

I am a MSIII planning on going into full time mission work. I was hoping to get your impression on which specialty would best enable me to be effective in the third world. Right now I'm torn between surgery and EM.

Any thoughts?


I am the Great Saphenous!


"He is no fool who gives what he cannot keep to gain what he cannot lose."
Jim Elliot

peds. there's no hope for the adults. the kids are the future of the third world, and the parents would probably rather have you treat their kids first anyway. 🙂

 

[quideam]

Be careful though. I know a guy who worked in the Congo as a missionary from the ER. One of his friends joined him there and there was a rebel uprising near the village where he worked. His friend left before things turned south. Eventually, the rebels moved into the village and took him hostage and held him at gunpoint. His friend went back to find him and thought he was dead. It turns out the rebels thought he was a priest and spared his life. Oh wait - that was on ER. Never mind...

Excellent!! As I was reading that, I thought "hmm, this sounds familiar..."!! Nice!

 

[VentdependenT]

I thought everyone was good at the missionary position?

 

[obecalp]

Thanks FoughtFyr and Niner for the info. I'm kind of torn in three ways between FP, EM, and ID. I guess, we'll see how rotations go. Thanks again!

 

[FoughtFyr]

Thanks FoughtFyr and Niner for the info. I'm kind of torn in three ways between FP, EM, and ID. I guess, we'll see how rotations go. Thanks again!

If you decide to go into mission work, regardless of specialty, I strongly urge you to consider an MPH in Environmental and Occupational Health. Why? I'm glad you asked. One of the biggest victories in public health is the reduction of communicable diseases through basic water hygiene. Drinking water treatment, waste management etc. go a long way to improve health in third world areas. There is a great program (IMHO) at the University of Illinois at Chicago in this discipline, and they have a track for residents (albeit in Occupational Health, but they are used to tailoring things for residents).

Check them out here: http://www.uic.edu/sph/eohs.htm

- H

 

[GreatSaphenous]

I've been looking into MPH programs. So far my favorite is Tulane in Louisiana. They offer a MPH-TM emphasizing tropical medicine.



I am the Great Saphenous!!

 

[mikecwru]

My suggestion to you, is to pick a specialty you fall in love with on its own merits, with the assumption that you may leave missionary medicine one day. You're not going to find a certain specialty that is going to be perfect, but the ones discussed: EM, FP, general surgery are overall decent choices. Medicine is much too specialized and you're going to be deficient in some areas. Plus, I would suspect that conditions in some places will be so horrendous, that a lot of the specialty training you're worrying over will be for nought anyway (ie, you'll be using antibiotics from the 1970s, etc). Choose the specialty you actually LIKE.

mike

 

[obecalp]

If you decide to go into mission work, regardless of specialty, I strongly urge you to consider an MPH in Environmental and Occupational Health. Why? I'm glad you asked. One of the biggest victories in public health is the reduction of communicable diseases through basic water hygiene. Drinking water treatment, waste management etc. go a long way to improve health in third world areas. There is a great program (IMHO) at the University of Illinois at Chicago in this discipline, and they have a track for residents (albeit in Occupational Health, but they are used to tailoring things for residents).

Check them out here: http://www.uic.edu/sph/eohs.htm

- H

Hey, thanks alot for the heads up! I'm glad that UIC has a decent MPH program. I"m hoping to come back home to Chicago in a few years.

 

[Nof55]

I would also vote for EM, though it would tie with surgery. A number of the EM staff at my residency do mission work on a regular basis. One is the past president of Doctor's without Borders if that is any indication of what your can do with EM. On the other hand the missionary elective I was set up for in 4th year was with a surgeon in Africa.

Nof55

 

[doc05]

surgery. EM would be #2, but if you can't do surgery, you'll be very limited.

 

[GreatSaphenous]

What about a FP residency followed by one of the EM fellowships for FPs in Tennesee?