Practical tips for medical volunteers

A recent recruit has some advice that can make the experience easier.

By Rebecca S. Kightlinger, DO
Ob/Gyn, Erie, PA

Your office "walls" are loosely hung blue tarps, and dogs are sneaking under your exam table to escape the flies. Patients come to you for tonsillitis, back aches, hypertension, breast cancer, parasites—all the usual stuff. And you take care of them the same way you care for your patients at home: You listen, examine, and treat. After a while, you forget you're practicing medicine in a garbage dump in a foreign country.

That describes the volunteer work I did in Mexico City in July 2001, and again this past summer. There, I left behind all the routine hassles of practice in Pennsylvania. People came to me for help, and I helped them. It was that simple.

I took care of families living in homes constructed of tarps, chicken wire, and bed springs. The parents and older children worked in the dump, salvaging items and selling them to the dump's owners in exchange for a few pesos and the "privilege" of living there. For one woman I treated, moving to the dump was an improvement. "I used to live in a really poor place in the mountains," she explained.

Many physicians would love to serve as medical volunteers, but language barriers, financial concerns, time constraints, or the limitations of their specialty intimidate them. These are all pretty easy to overcome, especially with the help of organizations that arrange such assignments for doctors, all over the world. (For a listing, see "Want to learn more?".) For instance, you usually don't have to speak a foreign language to volunteer; most of the larger organizations make translators available.

My first stint as a volunteer lasted seven days. However, sacrificing even so much as a week can be difficult for busy physicians. For a variety of reasons, it took me three years from the time I was asked to go to Mexico City until I was finally able to get there. I equate it to having kids: There's never really a convenient time, but once you do it, you wonder what took so long. Volunteering won't be as difficult as you think, and it'll mean more to you than you could ever imagine.

Nothing can prepare you for what emotions you'll feel while doing this work, so I won't try. But I can offer you some practical guidelines in a number of areas.

Meetings and networking. You'll be encouraged to attend one or more meetings to help you become acquainted with local customs. Don't miss these meetings. Experienced members can give you tips that might never occur to you otherwise.

Talk with other doctors who have been on the trips you're interested in, and find out what equipment, medications, and reference materials are available. On my first trip to Mexico, I had only a PDR and The Sanford Guide to Antimicrobial Therapy. For a gynecologist treating both males and females, from infants to the elderly, these books were helpful but not sufficient. Fortunately, since it was my first trip, there was another doctor— an emergency physician—to assist me. We triaged according to one rule: If it had testicles or diapers, it went to Dr. Mike. I did the rest.

In the months preceding my second trip, I spoke with family physicians and pediatricians about the cases and conditions I'd seen most frequently, and how they should be treated. Through these colleagues, I learned how to manage pediatric infections and prescribe antibiotics for kids.

Equipment and medications. Don't arrive at your destination empty-handed, unless you're told not to bring anything, which is unlikely. In Mexico City, I knew we were going to set up in garbage dumps, so I asked my hospital's OR staffers to collect drapes of all kinds and anything else that would keep surfaces clean. I brought disposable plastic speculums, a battery-operated headlamp that my husband found in a camping catalog, and all the wipes, swabs, Betadine, alcohol, gauze, and tape I would likely need. Thankfully, the organization's physician-liaison knew what was available and what would be helpful to bring.

If your group needs medications—and most do—pharmaceutical representatives can acquire stock bottles of common drugs, packed specifically for medical volunteer trips. In addition, MAP International, a nonprofit Christian relief organization, markets volunteer "travel packs," loaded with analgesics, antibiotics, bandages, topical creams, and vitamins. Each pack, which costs $400 and includes a donation receipt for tax purposes, is made up of two boxes that equal the weight of one piece of checked luggage. The pack also includes a slip that certifies the contents for Customs, making it ready for travel.

Food and clothing. Ask about snacks and water. Our workday didn't include lunch breaks, but we knew this ahead of time and were encouraged to bring something to eat. Granola bars or sports bars are good because they're small and individually wrapped.

Scrubs are good because they pack and launder easily. Lab coats are also useful because of the pockets. But use a short one: Long ones drag in the dirt when you sit down. Take knee socks, too, so you can tuck in your pant legs and tape them, to keep insects off your skin.

Another tip: Bring older casual clothes to wear during your time off, and consider donating most of it to the locals when you leave. This goes for socks and shoes, too.

Miscellaneous. Because hygiene is usually an issue in underserved countries, during the year I collect little toiletries from hotels to take to my patients. I ask my friends to do the same. And I check with local dentists for toothbrushes and toothpaste. I've also had luck getting free soap samples from manufacturers.

Wherever you go to help the poor, remember that you won't be captain of the ship; you'll be expected to be a team player. You won't have everything you'll need, or be able to order the diagnostic tests you'd like. And no one will hop to it if you bark. The staff will look to you not for orders but for guidance and leadership. Patients will be kind to you, and you may find yourself feeling calmer and more compassionate. For most of you, that will be reward enough.

Want to learn more?

The following organizations offer volunteer opportunities in foreign countries. Before you make a decision to work through one of them, double-check which expenses you're responsible for. However, your costs—including any membership dues or application fees—are tax-deductible in most cases.

Operation Serve International ( www.operationserve.org; 513-939-2000). This nondenominational, Christian mission service provides medical, dental, and eye care. It offers short tours of 8-14 days to Mexico and Egypt. Volunteers are expected to pay for their own airfare, hotels, and meals.

Doctors Without Borders ( www.doctorswithoutborders.org ; 212-679-6800). Not affiliated with any religion, this group provides medical assistance worldwide and picks up all of your costs for volunteering. It requires a minimum six-month commitment for new recruits, although assignments of nine months to a year are typical. Experienced anesthesiologists and general surgeons, however, may be able to serve for as few as six weeks.

Doctors Of The World (www.doctorsoftheworld.org; 212-226-9890). Based in New York, this organization has short- and long-term openings for physicians and mental health professionals both in the US and abroad. (Most foreign tours include airfare plus room and board.) Some of its volunteer work—such as reviewing the medical records of prisoners—can be done from your home or office.

Rebecca Kightlinger. Practical tips for medical volunteers.

Medical Economics

2003;6:57.