Mission medicine 2.0

Shortly after emigrating from Italy to Washington, D.C., in the 1940s, Joseph Aloi, M.D.’s grandmother and her brother became ill.

“They were taken care of by physicians—providers that volunteered their time to take care of people without resources in Washington, D.C.,” says Aloi, who is chief of endocrinology at Wake Forest Baptist Health. “I’m very much aware that my family experienced the generosity of strangers, so I feel that it’s important to help pay that back.”

Aloi has been able to do just that after finding a nonprofit health organization that made volunteering possible with his busy schedule. He has served annually for almost a decade and a half, proving that even with a full-time workload, physicians can find ways to volunteer nd enjoy the benefits of medical mission trips. Read on to learn more about three organizations helping physicians serve patients across the world—even from the comfort of their own homes.

Reaching the world: International Medical Relief

From booking travel plans and learning about another culture to getting the proper licenses and ensuring safety, there is a lot to do to prepare for an overseas medical missions trip. It can be daunting for many first-time volunteers who want to give back, but who don’t know where to start or who don’t have time to do all the legwork themselves.

That is what inspired Shauna King, MPH, to found International Medical Relief (IMR). She was working for a nonprofit health care system in Colorado at the time and realized there was a need for simple, worry-free ways for physicians to volunteer. “I had a lot of doctors looking for opportunities to serve and was just trying to find one that was a really simple way for them to give back,” she says. “It became a calling to start the organization.”

King now leads a team that makes overseas missions as turnkey as possible.

Lynnette Morrison, M.D., saw this turnkey experience firsthand when she first traveled with IMR to Ghana in 2011. “I was so impressed by their organization—just how everything was set up,” she says.

Morrison was a medical school student at the time. That first experience with IMR influenced her career path. “I actually went to a rural family medicine program because I was inspired by the work overseas,” she says. “In rural family medicine, it’s more like what we do in the mission trips. You don’t have specialists. You’re relying on what you can do, what you have access to.”

Since that trip to Ghana, Morrison has traveled with IMR five more times: twice as a resident and three times as a practicing physician. It has taken her around the world, including Uganda, the Philippines, Panama, Zambia and Senegal. She says these experiences have made her a more well-rounded physician for her patients back home, where she works as a family physician with a specialty in wound care at MedExpress Urgent Care in Springdale, Arkansas.

Her mission work has also influenced her personal outlook on life. “It really is rewarding,” she says. After seeing families in developing countries make do with so little, she has found herself focusing less on material goods.

IMR offers a wide variety of trips, some more rugged than others. “We work with a lot of indigenous tribes, so when we do that, we are obviously in a much more remote area,” explains King. “But then we work in some locations where they have really, really beautiful accommodations or resorts. There’s still a lot of need, but team members can be more comfortable.”

For each of these trips, IMR prepares its volunteers ahead of time. “We want our teams to go into the field feeling comfortable and confident,” says King. “We do a lot of pre-field training.” King and her staff use online training and conference calls to help team members prepare. These calls, along with Facebook groups, also allow team members to get better acquainted before they travel together.

IMR offers continuing education credits through pre-field training, so some employers may reimburse part or all of the cost of the trip. A trip with IMR can cost anywhere from $2,500 to $4,500 per person, according to King. Some physicians pay these expenses out of pocket and view it as a donation, while others raise funds for their trips.

“We actually have a customized fundraising portal,” says King. “It already has a sample letter in it, so they don’t need to do anything except send it out. And then 100 percent of the money that they raise goes directly into their account to offset their trip.”

Most of IMR’s clinics have a primary care focus, but physicians of all specialties are needed. “We take physicians of all capabilities and varieties,” says King. “Our clinics are really basic…so if a physician has been specializing in a particular area for a long time, they might be getting back to the basics of the grassroots of medicine.”

A typical IMR trip lasts just seven to 10 days, but IMR maintains long-term relationships in the area to ensure continuity of care. “We want to have sustainable solutions for the communities that we serve,” explains King. “We have long-term solutions with short-term opportunities.”

This flexibility allows many physicians to work with IMR who would not otherwise be able to serve abroad. “I’ve talked to colleagues that have said, ‘I really want to go, but I don’t have the time,’” says Morrison. “I would say, ‘Go on one. Just go on one. It doesn’t matter where. Just go on one and have that experience.’ It’s very good to go somewhere that’s out of your comfort zone. You’re going to see things that’ll help you practice.”

For more information about serving with IMR, visit internationalmedicalrelief.org.

Serving stateside: The Health Wagon

You do not have to go overseas to make a tangible impact in the lives of patients who lack access to health care.

The Health Wagon, a nonprofit based in southwest Virginia, is just one of the many organizations working to provide free, accessible care. They offer a wide array of volunteer opportunities that do not require international travel and are ideal for a physician’s busy schedule.

“We serve the most vulnerable in our population that do not have access to health care,” explains Ashley Fleming, outreach coordinator for The Health Wagon. “The Health Wagon, with its mobile clinic and two stationary clinics, has remained a pioneer in the delivery of health care in the central Appalachian region for more than three decades.”

“The Health Wagon is probably the gold standard as far as the volunteer free clinic,” says Ernani Sadural, M.D., director of global health at RWJBarnabas Health and co-founder and chief medical officer at LIG Global. “It’s just run by extremely dedicated, compassionate people, then add in the southern charm of the people that work in The Health Wagon with the beauty of the landscape of Appalachia.”

The Health Wagon’s largest annual event, a three-day health clinic, happens every July in Wise, Virginia. They find creative ways to work with the resources available. The event is held at a community fairgrounds, providers see patients in barns, and the pharmacy is in an 18-wheeler. Patients come from all over Appalachia to be seen. Some even spend the night in the parking lots for a chance to see a doctor.

“They’re very appreciative, so that’s a big reward of being a provider there,” says Aloi, who has served with The Health Wagon annually for almost 15 years.

“The fact that we were able to practice medicine just for the pure sake of medicine for the fellow man without respect to compensation … makes for a purely enjoyable experience, whether it’s for one day or one week,” says Sadural. “One comes back enriched and invigorated, hopefully even renewed in their faith in their life’s work and purpose.”

To allow volunteers to make a big impact in a short amount of time, The Health Wagon stays highly organized. “It’s remarkably efficient,” Aloi says. “Your time won’t be wasted.” Because The Health Wagon has a permanent presence in the area, they are able to help with continuity of care after a physician’s trip is over.

“We tailor patient schedules to fit the needs of our volunteers,” says Fleming. “Volunteers can come for a few days or for a couple weeks—whatever works best for them.” Plus, physicians from all specialties are welcome.

Volunteers cover their own travel and lodging, and out-of-state providers must have a temporary volunteer medical license through the Virginia Board of Medicine. The Health Wagon recommends allowing two or more weeks for this. Aloi says the state of Virginia typically makes licensing a smooth and fairly inexpensive process. “For people coming out of state, it’s very easy to stay licensed.”

Volunteering with The Health Wagon or a similar stateside organization is a chance to learn more about life in other parts of the U.S. and develop a deeper understanding of others.

“I’m originally from Chicago,” says Sadural. “I’d never been to Appalachia, and I admit that I had my own preconceived notions.” Volunteering with The Health Wagon opened his eyes to what life was like for patients who did not qualify for Medicaid, yet could not afford health care premiums.

“I gained a deeper understanding and appreciation of these people,” Sadural says. “For me, that was the biggest joy—being accepted into their community and allowed to learn from them.”

For more information about serving with The Health Wagon, visit thehealthwagon.org.

If you are looking for a flexible opportunity closer to home, you can’t get much closer than volunteering right from your laptop. New telehealth technologies have made that possible, and innovative nonprofits like The MAVEN Project are using them to overcome geographic barriers and fill gaps in health care access.

“What we’re trying to be is Match.com meets Peace Corps for volunteer doctors,” says Lisa Shmerling, JD, MPH, executive director of The MAVEN Project. “We’re really targeting health care organizations where a primary care provider is accountable for the care of uninsured and/or Medicaid patients that have a problem getting access.”

The time commitment is a minimum of just four hours per month, with no travel time required. By pairing volunteer physicians with understaffed clinics, The MAVEN Project helps rural and low-income patients who normally wouldn’t get timely access to health care. In many cases, timing makes all the difference.

Shmerling recalls the story of one hematologist volunteer who realized a patient had a treatable form of cancer. “The patient was going to go into renal failure within days if they didn’t get seen,” says Shmerling. “We were told that the patient was scheduled to see an oncologist, but not for another month. So, that was an example where we really escalated the issue, and the patient was seen within days.”

David Hurwitz, M.D., a California-based rheumatologist who has logged over 100 volunteer hours with The MAVEN Project, echoes this. “The patients have been waiting forever to see a rheumatologist, and they’re very grateful for getting a consultation,” he says. “Both the clinic staff and the patients seemed on the whole very grateful for my help.”

Hurwitz says volunteering through the The MAVEN Project has helped him carry out his passion for treating patients who otherwise couldn’t see a provider. “I’m a big believer in extending medical care to the population as a whole,” he says, adding that often there simply aren’t enough physicians to see all the patients who need to be cared for. “I saw that there was some way to help meet that need, which is what MAVEN was structured for.”

Depending on what each clinic needs and whether a volunteer physician is licensed in the same state as the clinic, MAVEN volunteers may serve through direct consultations, curbside consultations or mentoring. In direct consultations, the physician builds patient relationships and consults on individual cases. This typically happens with more complex cases and requires a physician to be licensed in the same state as the patient.

A day before each direct consultation appointment, Hurwitz says he typically gets a summary from a secretary, as well as access to electronic medical records. “A nurse would bring the patient in and introduce the patient to me,” he explains. “Then I’d see the patient, and a doctor would come in, and I would discuss the diagnosis and the plan with the doctor.”

In curbside consultations, however, a volunteer physician is not directly involved with an individual patient. Instead, he or she offers advice about a panel of cases. “Each state defines it differently,” says Shmerling. “It’s as if you were in the office and you’re getting a walk down the hall and you ask your pal, ‘What do you think about this case?’”

In mentoring relationships, a seasoned physician volunteer offers expertise to help clinic staff improve their services. “You get paired up with a nurse practitioner, for example, on a regular basis,” Shmerling explains. Mentees can use the sessions to learn about specific medical issues, get business advice or simply ask questions they have never had a chance to ask elsewhere. Says Shmerling: “Our ultimate goal is to increase the capacity at the health center.”

Shmerling says the organization works to make the technological side of things easy for volunteers. “We use a technology called Zoom,” she explains. The HIPPA-compliant application is quick to download, and it allows physicians to video conference, see patients and even share screens.

The MAVEN Project also smooths the process by covering malpractice insurance. Any physician who has been in practice for at least two years is welcome. Some of The MAVEN Project’s volunteers are retired physicians who want to continue making an impact.

Without the barriers of travel time, insurance costs or technological difficulty, you can easily get involved and help fill gaps in health care availability across the U.S.

Shmerling, who has been with The MAVEN Project since it was founded in 2013, hopes the number of physicians who regularly volunteer with health care organizations like hers will continue to grow. She says, “We would like to see a trend where someday everyone who’s in practice gives back by volunteering for some of these most vulnerable populations.”

For more information about serving with The MAVEN Project, visit mavenproject.org.