Travel is one of our passions. Spending time in unique places, trying new foods, and meeting different people is enjoyable and exciting. We are also passionate about our jobs as Otolaryngologists. Humanitarian trips allow us to combine both of these loves.
I have been fortunate to perform humanitarian trips on three continents. Each has had unique rewards and pitfalls. I began my international work by training health care providers to small villages in Myanmar. My next experience involved operating and providing clinical care in Kenya. Most recently, my wife and I traveled to Mexico to operate and provide clinical care in an underserved area. During these trips, I have repaired cleft lips/palates, removed cancers, reconstructed facial disfigurations, and improved breathing and swallowing. Few things are more gratifying than being able to provide life- changing operations without expectation of payment and with the realization that had you not been present in that time and place their lives would likely be considerably worse.
More so than previous generations, millennials are known to value spending on experiences. Service-related trips are becoming increasingly popular. After multiple humanitarian trips, I now feel fairly confident in my ability to plan and prepare for them. Before embarking on a mission/humanitarian trip—medical or otherwise—I believe you should be aware of several considerations:
- Motivations— Why do you want to spend thousands of dollars, use valuable vacation time, and travel to a foreign country to volunteer your time and expertise? Try to tailor your trip selection to your motives. If you are looking to combine leisure with service, plan a destination that offers both experiences. If you want an adrenaline rush, look for a more remote and less structured experience.
- Finances— What is the opportunity cost of missing work? What is the price of travel and accommodations? If going with an organization, what fee is charged? What is included? Are there miscellaneous expenses (hotel transfers, visas)? Will you have to pay additional money for patients who can’t afford surgeries if being charged (it happens)?
- Vaccines— If you are leaving North America then you probably will need some shots. Check out the CDC travel website or schedule a consult with a travel medicine physician. Consider checking with your local health department to see if a specific vaccine is offered (often much discounted compared to a physician’s office)
- Safety—The state department website provides a comprehensive list of any country in which you may wish to volunteer. Similar to the hard, honest look required to assess your motivations to volunteer for a trip, your risk tolerance is also something of which one should take a personal assessment. There is no wrong answer.
- Need— Are your services needed? No one wants to waste their time and energy to discover that they are unable to provide any assistance. While I was a resident there was group of ambitious medical students who arranged a surgical trip to Vietnam. They recruited medical students, residents, and attendings. Upon arrival, they realized something was lost in communication as the receiving hospital did not even allow the attendings to scrub for cases. The hospital thought the fellowship trained, world-renowned surgical oncologists were coming to observe only. They had no perceived need for any outside assistance.
- Follow-up— If you’re operating in a foreign country is there someone trained to manage post-operative complications, remove drains, etc? This may not need to be someone in your specialty but it should be someone who is competent to handle any issues that may arrive unless you are planning on sticking around during the acute complication phase. Some trips I have been on have had an ENT surgeon arrive as I was leaving (Mexcio), some had native ENT surgeons present (Kenya), and others had general surgeons capable of handling drain removal/hematomas if they had occurred.
- Malpractice/licensing– This varies widely. Check with your malpractice provider, the organization with which you will be travelling, colleagues who have been to the specific country and the medical licensing board of the country you will be entering. Some countries require temporary licenses be obtained.
- Supplies required— Are you in an OR with the tools you need? What are the absolute minimum instruments and suture required? Do you need to bring these? Can you buy them in the country? Can you get them through customs? Can you bring them back?
- Personnel – What people do they have in house? Will they be available for your use? Will they be competent? What is the anesthesiologist situation (I usually recommend bringing your own…), the nursing situation, the scrub tech situation, post op care?
- Customs—What can you bring? How much will it cost? I recommend bringing an invoice for items you carry, and, if possible, a letter from the organization you will be serving stating that you are donating the items in your bag (I’ve been stopped and had to use these items to get through unscathed 2/3 of the time).
- Expired medications—Don’t bring expired equipment or medications. If you would not use it on your patients at home you should not use it on patients abroad. The ethical question of “is expired medication better than no medication” has been asked and answered.
- Personality-Do you require specific surgical instruments in a specific order for each surgical case? Do you require ten minute case changeovers for your personal sanity? The more rigid you are the less likely you will have the temperament to thrive operating in an international mission situation. You either need to have (or fake that you have) a more laid back demeanor than most surgeons typically have. Changeover will be longer, miscommunications will occur, instruments will be lacking, and OR workers will not know your preferences as they do at home. Enjoy the good work you can provide when you can provide it. Focus on the patients you are able to help and spend time between cases practicing the language, appreciating the culture, or reading a good book.
Humanitarian trips are immensely rewarding and can provide care for those who would otherwise go without. I have loved my three international experiences. My wife and I plan to continue to make service travel a priority as we progress in our careers.