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January 11, 2021

Adventure bound

Practicing medicine may indeed be your idea of living the dream. But face it, there are times when the reality is not so appealing - especially during a pandemic. So when things return closer to normal, you may find that you have to get away from the daily grind just to love what you do again.

That doesn’t mean sidelining your skills is a necessity. Using them in a setting far afield from your professional home can have enormous upsides in terms of your attitude and energy (especially after a year where travel has been limited). New connections and discoveries may even change your perspective on life and work.

But what activities can produce the kind of trifecta of positives that you need? These opportunities might use your skills, energize your mind and give you a new lease on life. They may be worth vacation time - or even a short leave - from your day job just to live the dream again!

Campfire medicine

If the thought of rustic cabins tucked among soaring pines evokes warm fuzzies, then summer camp could offer an alluring break from your practice routine. Here’s one option that might spark your interest if you’re looking for a real feel-good woodland adventure: The Hole in the Wall Gang Camp. Founded in 1988 by movie legend Paul Newman, it’s all about giving children with cancer and other serious conditions a safe place, nestled on 300 acres near Ashford, Connecticut, to experience all that summer camp has to offer - fun, friendship, and the ability, in Newman’s own words, "to raise a little hell."

Where do physicians fit? They’re key in creating an environment in which participants can enjoy the transformative, even healing, aspects of camp life while still under the unobtrusive eyes of a medical team. In short, they’re helping kids just be kids! "When I tell people what I do, I get sad faces," says David Nelson, M.D., the camp’s medical director. "But if they came to camp, they’d see a bunch of mostly strong kids smiling and laughing. Some, of course, require assistance. But, in general, they’re just like other children having fun!"

Is this adventure for you?

Besides a year-round medical team, the Hole in the Wall Gang Camp is reliant on 28 to 30 volunteer physicians to staff typical fall and summer seasons. Four to six of them are needed for each week-long session to assist Nelson or another lead physician in caring for 120 campers. They represent a variety of diagnoses, from pediatric cancer and blood borne diseases to HIV/AIDS and other rare or serious conditions.

Although the focus traditionally has been on hematologists/oncologists, the team routinely taps others, particularly pediatric subspecialists whose young patients may even be campers. Whatever your background, since much of camp care involves ordinary scrapes, bumps and bruises, you might find a comfortable niche.

Topping the list of key qualities are compassion and the ability to operate in an environment that prioritizes creativity and teamwork. You may be used to a very structured setting in your day job, but camp medicine requires flexibility backed by safety. Would you be comfortable, for instance, being called to a fishing hole to do your initial check just so the patient doesn’t miss a camping beat?

"We very much rely on teamwork," Nelson says. "We’re not hierarchal in terms of ’the doctor is in charge.’ We’re about everyone working together in the best interest of a child. So, we like to hear that providers are used to and comfortable in a teamwork setting."

What should you expect?

Delivering care to Hole in the Wall Gang Camp campers is actually a bit of a critical mixed bag. Your potential patients - children, ages 7 to 15 - are at various phases of their treatment or disease and cleared by their physicians for the rigors of camp life. Not surprisingly, they can’t require the type of advanced care they’d normally get at a clinic or medical center. As Nelson notes, "We’re not providing a hospital setting in the wilderness."

Instead, you’ll not only be handling the bug bites, tummy aches and minor scratches kids get just being kids but, but more importantly, monitoring the tougher stuff related to their underlying health issues. Besides taking cues from each camper’s physician as to routine or next-step care, you have to be prepared to properly vet any situation. When a child complains of a headache, for instance, is it because of a busy day at camp or something more?

The reassuring news is that no volunteer assesses in a vacuum. There’s always another medical team member on site for comparing notes. In fact, you may be a little nervous at first because you haven’t worked lately - or ever - with seriously ill children. But you needn’t feel uncomfortable, Nelson says, if you remember that these are kids first and that "you’ll never be in a bubble" answering their needs.

Whatever the case, you’ll also be working from an infirmary that’s a tad more robust than your standard sick bay, set up to give even happy-go-lucky kids blood tests, IV fluids or infusions. If any situation requires more extensive attention - a child needs an X-ray or even hospitalization - it’s a quick transport to nearby Connecticut Children’s Hospital. "Even though we have the potential to take care of our campers, we’d rather be on the side of safety and send them to the hospital to be evaluated," says Nelson. "If they’re all clear, they come back to us."

What are the benefits?
Besides an adventure that’s definitely a complete break from the norm and just a lot of fun, there are a variety of feel-good and other aspects. For starters, your "pay" is in the satisfaction of delivering care to a very deserving patient base. If the campers are your patients - or like your patients - you even get to see them in a whole different light.

As to the overall experience? Nelson uses words like "invigorating" and "recharging" to explain what occurs to physicians in experiencing the respect, love and other core values that are the Hole in the Wall Gang Camp. By participating in what he calls "the magic" of everyone working together for a common goal, they’re energized with a new perspective for the daily grind back home. "It reaffirms everything that is good."

Call of the wild

If you love nature in the extreme, wilderness medicine may be just the ticket. Whether you enjoy taking on the mountains, traversing the back country or deep diving into the sea, a rugged environment can certainly offer a dramatically different view than what you see from your office window.

There are challenges nonetheless, given the injuries that can occur while you’re chasing daring or hazardous activities in unforgiving settings. Without a hospital in sight, it may be up to the nearest climber, hiker or diver to save a limb or even a life. If that’s you, you clearly have the medical basics to at least evaluate the situation. But an austere, out-of-the-way environment may demand more than what you’ve learned in residency.

So what’s the best way to prepare yourself? A wilderness medicine fellowship can give you a critical leg up in handling whatever issue threatens to sideline you - or someone else - in the wild. "Fellowship training can give you the skills you need to be healthy and safe, especially if you’re in the outdoors frequently," says Scott McIntosh, M.D., MPH, associate professor of emergency medicine at Salt Lake City-based University of Utah Health. "It can raise your confidence for taking care of yourself and others in very austere environments."

Is this adventure for you?

Wilderness medicine is a distinct field of study that attracts physicians and other practitioners with varied backgrounds. Whatever your specialty, you probably already have the primary credential: a love for the outdoors, whatever environment or activity matches your enthusiasm. Physicians who give wilderness medicine a serious look have various and sundry reasons, but it usually begins with the chance to blend two important "Ps" - profession and passion. Whatever takes them outdoors after office hours or hospital rounds, "wilderness medicine," McIntosh says, "allows that melding possibility."

Many others, however, just don’t want to be caught short-handed. They want the know-how to react quickly and effectively. "They’ll often say, ’If a family member or my partners get hurt in the middle of nowhere, do I have the skills to take care of them?’" McIntosh says. "That may be the most basic reason someone gets interested in wilderness medicine."

What should you expect?

Wilderness medicine and the fellowships aligned with it have become increasingly relevant as people turn their recreational sights on austere places and/or daring or downright hazardous activities. Whatever the environment, "wilderness" is defined as being two hours away from an ambulance, hospital or clinic. (The concepts can also apply if a disaster cuts off easy access to primary services in a city.)

There are multiple opportunities to spread your wings. For starters, the Wilderness Medical Society and its education partner, the Academy of Wilderness Medicine, offer a multi-year fellowship. Combining conference attendance with coursework and hands-on work, the tract leads to "FAWM" certification.

If you want a traditional one-year program, you need not look further than the 15 or so wilderness fellowships throughout the country. Although housed in various departments, they’re usually centered in emergency medicine. Also, since this field often overlaps other fields, such as environmental, sports and travel medicine, you’ll likely be exposed to an array of skills that could be crucial in intervening, stabilizing, treating or even transporting someone in distress.

Each program has a core curriculum covering wilderness basics and overlays a specialty focus tailored to the immediate environment. With high altitudes, fast-moving rivers and even desert in their backyard, for instance, participants in the University of Utah’s Wilderness Fellowship Program are immersed in both wilderness and mountain medicine plus an introduction to air medical transport fundamentals. Once they’ve cemented their skills, graduates are well-positioned to take on a panoply of problems - anything high-altitude sickness, an avalanche or lightning strike, skiing, climbing, hiking, kayaking, canoeing or whitewater rafting can cause.

In selecting a fellowship, McIntosh advises paying attention to some specifics. First, the direction should fit your outdoor pursuits, such as mountaineering or marine. Second, it should be led by an experienced director with knowledge in that wilderness specialty. Third, the curriculum should include both teaching and hands-on experiences. Finally, it should sport a positive track record. "It’s important for any candidate to evaluate the specific features," McIntosh says. "It should be an established program, well-positioned for excellent training that helps you succeed."

What are the benefits?

The beauty of a wilderness medicine fellowship is that you can apply what you learn either part time or just when you’re facing the elements outdoors.

Besides maintaining an emergency medicine practice, McIntosh turned his love of rugged places and volunteer activities into an essential part of his career, largely teaching like-minded individuals how to take care of themselves and others.

Your wilderness medicine experience may not be so encompassing. Yet by fine-tuning a whole new set of skills, you’ll be ready to provide hands-on help when a fellow adventurer needs it.

Lasting imprint

If you want to do good in the world, you won’t find many options as fulfilling as practicing medicine abroad. Delivering care in some of the most challenging and even hazardous parts of the globe definitely fits the definition of "adventure."

Here’s one far-from-home option that will likely take you out of your office comfort zone while reigniting your love of medicine and leaving your professional stamp long-term. The sole purpose of Health Volunteers Overseas (HVO) is to improve the availability of quality health care by teaching, training and developing health professionals in resource-strapped countries.

How does it differ from other medicine abroad activities? Instead of swooping in to address the immediate health care aftermath of a crisis, conflict or disaster, its sights are set on the long-term. As Nancy A. Kelly, MHS, executive director of HVO, notes: "Many of our physicians have done medical mission work, but they get to a moment when they realize there’s always going to be a line outside the clinic. There’s always going to be demand. They’ll even tell us, ’You need to focus on teaching to grow the capabilities in the country.’ That’s what we do."

Is this adventure for you?

If you love the idea of touching the future, HVO may be an adventure worth a look. Although the initial thrust was in orthopedics and anesthesia, today’s agenda involves a variety of medical specialties, from pediatrics and internal medicine to oncology and hematology. With a volunteer roster of physicians and other health care providers, HVO has a broad personnel base to support 90 projects, each designed to meet the specific needs of a host.

Who might qualify? HVO looks for experienced clinicians and/or academicians with at least three to five years under their belt; the more the better. The best candidates are also nimble problem solvers with a sense of humor and great interpersonal skills. They’re not only capable of easily shifting from Plan A to Plan B or even C, but they also aren’t easily offended if the advice they offer isn’t implemented. "You have to listen, step back, and just take in what’s happening," Kelly says. "You don’t want to push forward with a suggestion until you have a better understanding of what’s going on."

For their part, HVO volunteers have a mindset for sharing knowledge and a penchant for discovering new cultures. But driving it all is a keen sense about lasting differences.

Charles Blitzer, M.D., a New Hampshire orthopedic surgeon, is a veteran of other medicine abroad experiences. Yet HVO projects in Bhutan, Malawi, Costa Rica, Mongolia, and Ghana have allowed him to do more than operate and move on. "HVO understands what this sort of work should ideally be, which is education and having a sustainable model," he says. "With HVO, you’re basically there as a visiting professor, working alongside the local talent."

What should you expect?

HVO partners with host governments and teaching institutions over projects tailored to specific medical needs and educational priorities. The organization’s reach extends from Central and South America plus the Caribbean to Africa and Asia. Most commitments are several weeks to a month with volunteers likely going it alone. "HVO is very sensitive in keeping its volunteers out of inappropriately risky places," Blitzer says. "But you still have to be comfortable traveling into foreign lands without other Americans at your side."

Physician Art Design

Education occurs in both formal and one-on-one settings with volunteers sometimes demonstrating their specialty techniques beyond physicians. In the African Republic of Malawi, for instance, Blitzer’s coworkers were "clinical officers," physician assistant-level providers carrying the baton in the absence of full-fledged surgeons. Regardless, the teaching mission focuses on what they can do with what’s available. "The model is more about principles and recognizing what their resources are," Blitzer says, "because that is fundamentally what counts."

Although medical issues differ with each project, patients are often seeking attention well beyond an easy fix. For instance, bone and joint infections are rare in North American orthopedics, but Blitzer has seen his share in patients who present long after the village-based resource first took a look. "There are problems that we’re very familiar with and problems that we have no familiarity with," Blitzer says, noting that he’d never encountered tuberculosis of the hand until seeing it in Bhutan. "Hopefully, we’re educated enough to understand the principles that we should be thinking of in offering help."

What are the benefits?

Besides discovering something about yourself, a medicine abroad adventure can change your perspective about the world and your profession. Blitzer, for instance, enjoys being the only HVO physician in a department so his primary exchanges are with locals. Although every project makes him "tremendously appreciative" of being an American, he says, "there’s a real benefit in learning what the rest of the world is like."

As for reconnecting with medicine, working abroad can definitely bring you full circle in loving your profession. "It’s doing medicine the way I think most of us who are admirers of medicine envisioned it," Blitzer says. "It’s purely about taking care of patients. It’s all about what you went into medicine to do, and that’s particularly satisfying."



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