Lucy Doyle, M.D., had never imagined that life after residency could be so hard. But as an internist working with the French-based Doctors Without Borders organization, she found herself the only physician in a small expedition party making its way to a village stricken by cholera. Although she was stationed at a nearby hospital, she and a team had set off through the jungle to help. “It was a two-day trek,” she recalls. “Walking through that jungle was the hardest thing I’ve ever had to do in my life.”
Midway on their journey, the expedition team ran into a couple carrying an infant son. The baby, a victim of the cholera outbreak, was unconscious and the desperate parents had decided to walk to the hospital for help. Fortunately, the hospital had come to them. “I took an IV from my bag and revived him enough so he could drink,” says Doyle. Extra fluids were given to the parents, along with instructions to keep their infant drinking as they walked. Then both parties continued on their respective ways.
A month later, Doyle returned to the hospital in time to see the infant just before he was discharged. “The difference was remarkable,” says Doyle. “When I saw him, his eyes were sunken in and he was not responsive. Now, he was a typical child, looking well and playing.”
Just another life-saving day in the world of medical missions.
Mind you, this kind of work is not for the faint of heart. But if saving lives, making a difference and practicing medicine in order to help— really help—people, then mission work may be for you. There are plenty of opportunities out there for physicians who want to lend a hand. Whether you want to travel abroad, stay stateside or work close to home, the need is there, and it’s never been greater.
Here are four ways you can help, both domestically and internationally.
Remote Area Medical (RAM) Volunteer Corps
Learn more: ramusa.org
When Stan Brock was a teenager, he worked for a time as a cowboy on a Brazilian cattle ranch that butted up against the Amazon rain forest. As the newest—and youngest—employee, Brock was given a horse to ride that was so wild it had been named Kang, the devil.
Kang had already thrown two previous riders by the time Brock mounted the horse. He would be the third rider to go flying off, sustaining substantial injuries in the process. The nearest hospital, however, was 26 days away—on foot. The nearest doctor was a three-day walk away.
Brock was young and tough and he recovered, but he never forgot the experience of being days away from medical care. That’s why he founded the Remote Area Medical (RAM) Volunteer Corps, which brings health care to those who live in remote areas of the world, including the U.S.
When Brock brings his pop-up clinic to an area, it’s always advertised well in advance, and the news spreads quickly. By the first day of the weekend-long clinic, hundreds of people are lined up at the gates.
“I’ll stand at the gate and ask how many people are here to see a dentist, and nearly every hand goes up. Then I’ll ask who needs to see an eye doctor, and there will be another show of hands. Next, I’ll ask who’s here to see a doctor and a few hands go up, but not as many as for the first two,” he says. “Now, all of these people need to see a doctor, and we schedule as many as we can, but they see their dental and eye needs as more important because those are conditions that affect them every day.”
Diabetes, hypertension and other serious illnesses haven’t made the same impact on their lives—yet. But it’s just a matter of time, says Brock.
Joseph Smiddy, M.D., would agree. As a pulmonologist, he has diagnosed emphysema, lung cancer, even black lung disease while working as a volunteer at RAM clinics.
“A lot of the areas we go into are coal-mining areas,” says Smiddy. But until recently, he and other colleagues had to depend on physical exams and stethoscopes to make their diagnoses. “I heard doctors say, ‘If only we could get a chest X-ray,” he recounts. So he decided to do something.
He bought an old tractor trailer and had it outfitted as a mobile X-ray unit, installing three state-of-the-art machines. “The clinics all use modern equipment, I want to emphasize that,” says Smiddy. “We don’t use old, hand-me-down equipment.” When the unit was road ready, Smiddy then carved 180 hours out of his busy practice time to obtain a tractor-trailer driver’s license so he could drive the unit himself to RAM clinics and other volunteer and community events.
Not every RAM volunteer rises to that level of dedication, of course, but a certain level of dedication is required of all RAM volunteers. For example, if you’re traveling to the clinic from out of state or elsewhere in the state, you’ll arrange for and pay your own transportation and lodging. And prepare to be at the clinic the whole day.
“We don’t do shifts,” says Brock. Everyone reports for work by 6:30 (the clinic opens at 5 a.m. for registration), and you’re likely to be there until 7 or 8 at night. All specialties are needed, although oral surgeons and ophthalmologists are most in demand.
If you decide to lend RAM a hand, you’ll need flexibility, endurance and a willingness to roll up your sleeves and pitch in for almost anything. You’ll also need a current medical license (and therein lays the rub for physicians who want to volunteer stateside).
“We need a federal law that allows doctors who volunteer in other states to do so without first obtaining a medical license in that state,” says Brock. He has testified before Congress on the matter, but although some states have passed “Good Samaritan” laws, as they’re known, not all states have and there has been no federal action on the issue. The American Medical Association has put together a state-by-state list of requirements for senior physicians who want to volunteer, and it’s probably the best of the resources out there.
All in all, says Smiddy, the experience will be worth it. Yes, he admits, it comes with a level of frustration that you can’t do more, but you’ll meet real people with real needs, and experience the feeling of actually helping these individuals. “That’s the reason I went into medicine,” he says. RAM is a good entry into medical volunteerism, he adds, “and it’s personally rewarding.”
The National Association of Free & Charitable Clinics (NAFC)
Learn more: nafcclinics.org, (703) 647-7427
Although the NAFC holds occasional pop-up clinics like RAM, “We have a very different model,” says Nicole Lamoureux Busby, NAFC executive director. “We use the one-day clinics to raise awareness of our freestanding clinics and to drive both patients and physicians to them.”
The NAFC is a loose consortium of 1,200 free and charitable clinics that have been set up in cities and towns across the U.S. The organization was founded in 2001 to advocate and serve as the voice for patients and physicians as well as other staff members who work there.
“The biggest problem we have is that many people don’t know these clinics exist,” says Lamoureux Busby.
Free clinics serve only patients who are uninsured, underinsured or who have no access to primary or specialty care. They operate much the way a doctor’s office operates, says Lamoureux Busby.
“The patient checks in, is triaged and is seen by a doctor,” she says. The physicians all serve on a volunteer basis.
NAFC is a good option for volunteering if you don’t want to travel or take a weekend off to travel away from home. You can work in your area, according to your schedule and for any amount of time—daily, weekly or monthly. Some volunteers may give five hours a week, some give 20 a month, and others may give 30 hours over three or four months, says Ariana Gordillo, NAFC’s outreach and operations manager.
All specialties are needed for both standing facilities and one-day clinics, though the greatest demand is for primary care physicians.
The experience will be rewarding, says Lamoureux Busby. “There are so many stories we could tell.” She recalls a mother who came to a clinic complaining she felt ill but didn’t know why. “She was diagnosed with stage 3 breast cancer,” Lamoureux Busby says. The woman was referred for treatment and has now recovered and is doing well.
Ed Weisbart, M.D., a family physician, has volunteered with NAFC for four years and recruits other physician-volunteers for NAFC in his spare time.
“When I volunteer out of state, they send me an application for a temporary license if it’s needed, and they purchase malpractice insurance for all of us who volunteer, whether a physician or not,” he says.
Some of the biggest problems, he says, occur because people have lost their jobs and their benefits, or their health care has been dropped by employers.It’s frustrating, he says, when people stop receiving life-improving or in some cases, life-saving drugs. He recalls an incident with a woman who came in with her mother. “She couldn’t put two sentences together,” says Weisbart. He learned she had lost her job, which meant she could no longer afford the medicine to control her epilepsy. “Her mother told me she has had epilepsy since she was a child and would have two to three seizures a day. With medication, she’d have two to three seizures a year,” says Weisbart. The woman was down to two to three weeks’ worth of medication and was so stressed about returning to more frequent seizures that she could no longer function normally. “We gave her a refill that was affordable, $40 for three months instead of the $1,200 pharmacy cost, and told her she could continue with that affordable prescription. The look on her face is one I’ll never forget,” he says.
Learn more: mercyships.org
For nearly 30 years, Mercy Ships, founded by Don Stephens, have focused on the plight of Africa, where nearly half the population has no access to a physician or to a hospital.
Stephens decided a ship was the best way to deliver health care for several reasons: At least 75 percent of the world’s population lives within 100 miles of a port city, so a ship could bring care to a vast amount of people. A ship could be maintained as a safe and clean environment, and it had its own infrastructure, its own water and electric supply. So Stephens set up his organization, acquired a ship, staffed it with volunteers and set it off on its task of delivering health care to those unable to access it.
“Mercy Ships’ current target area of service are the 17 countries on the West Coast of Africa between 15 degrees north and 15 degrees south latitude,” says Peter Linz, M.D., chief international medical officer. “These countries are among the poorest in the world and rank at the bottom of the United Nations Human Development Index.”
The Africa Mercy is the name of the ship currently in action. It serves as a specialized surgical hospital that offers direct patient care services as well as a variety of health education training to doctors and other healthcare workers in the area.
“The programs offered in any given country are tailored to the area’s specific needs,” says Linz. Care can include maxillofacial surgery, eye surgery, pediatric orthopedics, vesicovaginal fistula repair, general surgery and dental care. “There is much more demand for service than we can provide,” he adds.
Volunteers aboard a Mercy Ship serve short-term missions, from one to nine months, or long-term missions serving two years or more. Shifts are from 8 a.m. to 5 p.m., though cases may run overtime. Most volunteers, however, will work a minimum of 40 hours a week. “It’s not unusual for more than 4,000 patients to show up for screening at the beginning of a field service,” Linz says. On the most recent trip to Guinea, more than 2,850 surgical procedures were performed.
Mark Shrime, M.D., an otolaryngologist trained in head and neck oncology as well as reconstructive surgery, has worked on Mercy Ships since 2008, serving first in Liberia for six months, then returning five additional times. The shortest stint he has worked was two weeks.
“The most rewarding part of the work is obvious,” he says “It’s the ability to change a life—not just physically, but socially and economically as well. It seems like it’s just surgery, but it turns out to be more than that. There’s often a social, economic, physical and sometimes spiritual transformation. Getting to know these patients is the most rewarding part of the work.”
He tells of a 22-year-old man he met on his Guinea trip who had a mass on his jaw. “The mass, as it turns out, was a benign bony tumor that had been growing for the prior eight years,” says Shrime. “He was anemic and malnourished and, importantly, ostracized from his community.” The surgery took all morning. The entire jaw was removed and reconstructed with a metal plate, onto which a bone was grafted three months later. But, says Shrime, “he left the ship with a new smile and the right to look human again.”
Beyond helping patients, Shrime says Mercy Ships is medicine in its purest form. “The profit motive is removed; the medico-legal overlay is removed—all you are left with is what you went into surgery to do,” he says.
Doctors Without Borders
Learn more: doctorswithoutborders.org
This Nobel Peace Prize-winning organization is French-based (also known as Médecins Sans Frontières, or MSF), but accepts physicians from all over the world who want to provide care to those in need.
Most projects are overseas, although the agency did come to the U.S. in response to the emergency created by Hurricane Sandy a couple of years ago, says Lauren Cohen, a field human resources officer with Doctors Without Borders.
“When a doctor is accepted on our team, there is a general work commitment expected of between nine and 12 months,” says Cohen, though some specialties, like surgery and OB/GYN, may serve just one to three months at a time. The physician will be assigned a location based on the agency’s current need, as well as their skills, background and availability.
Once on location, you’ll assume a supervisory or consulting role, working in close collaboration with local physicians and staff.
“About 90 percent of those working at a location will be local physicians and health care workers,” says Emily Bristle, another field officer and recruiter. “About 8 percent are international doctors, and they may come from a variety of countries.”
Though all specialties are needed, Cohen says doctors with experience in infectious diseases and tropical medicine are most in demand. If you do become part of a Doctors Without Borders team, you’ll be expected to work six days a week, morning to early evening, though hours may be longer depending on emergencies or on-call needs.
Unlike the other organizations mentioned here, Doctors Without Borders will cover your transportation and lodging expenses while working on the job, and it will pay you a stipend as well.
Accommodations depend on the location where you’re assigned.
“When I worked in Kenya on the Somali border, we lived in tents near the refugee camp where we worked,” says Lucy Doyle, M.D. Later, when she worked in a hospital in the Congo, the environment was more stable and she stayed in a home.
You should also be prepared to speak French, as French is the “language of work,” says Bristle. “There’s no language requirement,” she adds, “but we look for French speakers, even if they’re not perfect.” Spanish-speakers, however, are also becoming an asset, Bristle says. “And Arabic is becoming more important.”
Doyle says she learned French before reporting for work. “It was pretty basic, but after about a month I could understand and be understood pretty well,” she says. And though patients would often speak Swahili or the local dialect, the local physicians and staff would translate their responses for her—into French.
“Check out the field blogs written by some of our field members,” Cohen suggests. “You can learn a lot about the kind of work that’s needed, and what a physician’s average day is like.”
Doyle says she will go back as a field physician again when her schedule allows. “I’m glad I went right out of residency the first time,” she says. “It’s a natural break in your career, and it’s an easier time in your life to make it happen. Also, residents are used to being flexible and are used to changing environments.”
That flexibility served her well as a Doctors Without Borders physician, she says, and it gave her invaluable experience.
“I’ll definitely go back someday,” she says. “And I recommend it to others.”
These are just a few of the opportunities out there—in your community, in the country and in the world. There are many from which to choose, and a bit of research will reveal those to which you may feel more drawn. “While no one can guarantee any experience will be life-changing,” says Shrime, volunteering will improve the odds. “I would say, ‘Do it.’”
Karen Edwards contributes regularly to PracticeLink Magazine.