The Challenges and Rewards of International Medical Volunteerism

A PRACTICAL GUIDE TO GLOBAL MEDICAL VOLUNTEERISM

We are seeing more physicians participate in short-term international medical work owing in part to a greater awareness for global inequities in health care. What types of volunteer opportunities are available to physicians interested in making a difference overseas and what are some of the most common challenges and benefits of working abroad.

You are listening to ReachMD, The Channel for Medical Professionals. Welcome to a special segment Focus on Global Medicine. I am your host, Dr. Jennifer Shu, Practicing General Pediatrician and Author. Our guest is Dr. Parminder Suchdev, Assistant Professor of Pediatrics and Global Health at Emory University and Medical Epidemiologist in the nutrition branch at the Centers for Disease Control and Prevention in Atlanta.

DR. JENNIFER SHU:

Welcome Dr. Suchdev.

DR. PARMINDER SUCHDEV:

Thank you.

DR. JENNIFER SHU:

What kind of physicians are interested in volunteering or practicing medicine abroad and do we know how many physicians are doing this?

DR. PARMINDER SUCHDEV:

I think the short answer to that is all physicians. I don’t think I know a physician or student in training who isn't interested in going abroad, lot of the reasons why people don't go abroad are for some of the financial constraints or constraints with their family or logistical issues, but I think if any was given the experience and will give you a week of vacation from your practice to go practice medicine in an X country, I think you would have a universal yes.

DR. JENNIFER SHU:

Are you finding that this is also true for other health care providers such as nurses, nurse practitioners, and physician assistants?

DR. PARMINDER SUCHDEV:

Absolutely in my experience I feel like some of the other medical professions are even doing more global health work than physicians and nurses and other practitioners you mentioned I think there is also a huge increase in global health activities as well.

DR. JENNIFER SHU:

Now other than being able to help patients overseas what might be some personal and professional benefits of international medical work?

DR. PARMINDER SUCHDEV:

There are several benefits, the most common being educational benefits as far as improving your clinical diagnosis skills, seeing diseases that you wouldn’t commonly see in the US. You know, here most of our common diseases are chronic illnesses such as asthma, heart disease, and when you go abroad, you are looking at more acute infections many of these that you do not see in the US, but I think one of the other main reasons people go abroad and work globally is the sense of social justice and understanding what the true determinants to illness are, some of the social determinants and those who do go abroad end up having attitudinal changes and are more likely to be involved in the community service and working with underserved populations in the United States when they return.

DR. JENNIFER SHU:

You mentioned that finances can sometimes be a barrier to participating abroad, what are some other challenges that physicians might face?

DR. PARMINDER SUCHDEV:

Another common problem is finding the time off and whether that is a vacation or salary support to go abroad, getting approval either from your department chair or your practice or your attending if you are a student to go abroad. I think those who aren’t involved in global health work sometimes think of working abroad as being more of a tourist activity and not having clear objectives in advance, can sometimes create a challenge as well. In addition, other challenges I think are language and not knowing the language, safety concerns is becoming an ongoing problem in many places of the world. There might be differences of religion those type of issues I think come up often.

DR. JENNIFER SHU:

Before we move on from challenges you mentioned that time can be an issue, but how much of time commitment is actually needed, do you need a week, 2 weeks, a month, a year?

DR. PARMINDER SUCHDEV:

I think that that is a tough question to answer, the common mistake is that okay I am going to go on 7-day trip to Guatemala for instance and all I really need is a week and I think you should multiply the length of your actual trip by 10 or something just in the preparation and getting your visas and your clearance and really collaborating with the local organizations and really having time for feedback and reflexion when you come back, so I think it ends up taking more time than is needed and the longer time you can commit, the better.

DR. JENNIFER SHU:

So, once a physician decides that they do want participate in short-term international medical work, what do they need to do to get started, how they decide where to go and whom to help?

DR. PARMINDER SUCHDEV:

That is a big challenge because there is so much information out there. If you type global health on Google or some other search engine, you will find thousands, thousands, and thousands of hits, and I think really the first step is sitting down either by yourself or with a mentor and defining your objectives, like what you really want to get out of it. If your main objective to go learn medical is your main objective to really improve your diagnostic skills, is your main objective to learn about research and go to a specific region in the world for whatever reason. I think having clear objectives in advance can help you narrow down your choices and there are many, many organizations out there and web sites that have useful information, the International Medical Volunteers Association is one I like, the Global Health Education Consortium is another great group and then all like American Academy of Pediatrics are those in pediatrics often have really good resources and it is nice to choose a program that has some type of accreditation, so you know you are investing both your time and money on something that is meaningful.

DR. JENNIFER SHU:

Are there are certain countries that you have visited that you would recommend to others who might be interested?

DR. PARMINDER SUCHDEV:

I don’t think there is any country I have been to that I haven't learned a lot from and I really had a beneficial experience. I spent lot of my international work in Latin America primarily because I speak Spanish and feel like I am more useful in the place where I can speak the language, but I have also spent time in Africa and Eastern Europe and Asia and so I think it is a personal preference for where you choose to work.

DR. JENNIFER SHU:

Are there different pros and cons to working with a smaller group or larger non-governmental organization for example or to try to be in a more academic setting internationally?

DR. PARMINDER SUCHDEV:

Again I think it depends what your goals are, if you want to make a larger scale impact may be get a publication, fill your CV, those working with a more academic program might be helpful, but small NGOs there are thousands of them out there and they are doing great work. I mean the work I did in El Salvador for instance, one of my good friends from medical school, her sister was living in El Salvador working for this NGO and that is the connection I had. I think as long as there is some of type of connection that is really how these collaborations and this relationship builds and when you have a relationship, you are going to get a lot more out of the program.

DR. JENNIFER SHU:

Now, one challenge we have talked about earlier is that finances may deter some physicians from being able to work internationally, are there are some creative ways to find either paid opportunities or ways to get things like food, shelter, or transportation covered?

DR. PARMINDER SUCHDEV:

Yeah and I think there are many ways to deal with some of the financial constraints, it is never easy, I mean I think the first step is making sure you know you can take the time off and lot of residency programs will allow you to go as an elective so that you are still getting paid your residency salary for instance or if you are in practice you often you have to use vacation time, but lot of the programs do provide housing and transportation costs. For example Health Volunteer Overseas is a great organization and so might you have to pay for your plane ticket, but then after that everything is covered, and there are other programs too, will actually will give you a small stipend, I think the bottom line is that yeah you do have to invest some, but the benefits are well worth the investment.

DR. JENNIFER SHU:

When physicians go overseas I often seen them collecting medical supplies and even non-medical supplies to take with them to leave in the local communities. What types of equipment would you recommend taking to a foreign country?

DR. PARMINDER SUCHDEV:

Yeah, this is a challenge I have often faced, I think early on in my short-term medical travel experience used to really focus attention on getting as many supplies as we could and leaving them behind and then I started realizing that lot of the supplies you are collecting might not have been the most useful to the local organization and often many of the medications we can get here in the US are those that are donated by pharmaceutical industries for instances things like azithromycin and fourth or third generation cephalosporins which in the local country that you are going to they are still using penicillin and amoxicillin and so you are introducing a very strong medication and then once they run out of it, they are not going to have anymore of that so, I actually think it is often better to go look at the local countries medication list and WHO has essential medication lists for every country and either raising money to help expand the pharmacy of these existing medications or bringing medications from that list to the country and the WHO actually has on the website a list of guidelines for donating medications and I think it is very helpful.

DR. JENNIFER SHU:

Have you found it helpful to bring practical items such as pens for clinic workers or even diapers for the children there?

DR. PARMINDER SUCHDEV:

Out side the medication context, I think there are lot of practical things that can be brought, for example my work in El Salvador we used to create these hygiene kits getting people go to hotels and have their little soaps that they get and collecting those and bringing hygiene kits with toothpaste, toothbrushes, soaps, I think that can actually be more useful to someone and not have some of those ethical concerns for medications that people don’t know how to use.

DR. JENNIFER SHU:

One criticism of these smaller scale efforts in local communities is that it that doesn't improve the broader picture of public health infrastructures throughout the world. What if a physician would like to contribute either time or money to an organization that works with multiple communities or tries to build these infrastructures what would you recommend for them?

DR. PARMINDER SUCHDEV:

As a single physician going out there, you are trying to put a band-aid on a gaping wound and is that really going to make a long-term difference, and is my money and time better spent giving a donation to an organization, I think that is great, and I think that is something that each person has to kind of decide on and I don't think I have any specific organizations to recommend because I think each organization has their own mission and their own values and I think depending on the individual donating resources is a great way to make a difference.

DR. JENNIFER SHU:

One further criticism that I have heard is that when we provide aid internationally, we may be neglecting poor areas of our own country, do you think that is a valid criticism?

DR. PARMINDER SUCHDEV:

Oh, absolutely and I think anytime I give a lecture on global health, I always start with the situation here in the US and those of us who practice in urban settings, see this even in rural settings, we have huge disparities in health care in our country and I think you can't practice global health without working locally and that is why there has been a shift from calling work abroad international health to global health, the difference is that in global health that we are part of the community and so I think prior to going abroad for instance I require my students to go work in our free clinics here in Intercity Atlanta to get a sense of what its like to work with underserved patient populations and that better prepares them for the work they will see abroad, but more importantly when they come back, will give them a better sense of appreciation to address some of those issues here.

DR. JENNIFER SHU:

What are the most important take-home messages you think physicians should know if they are interested in working in global health?

DR. PARMINDER SUCHDEV:

I think one of the big recommendations is to start early, I think it is easy to sign in for a trip that starts in the summer and then you know a week before scramble to get everything ready and that can be a big mistake, so really start planning early, make contact with the local organization and establish a strategy for communications, lots of projects fail when there is not effective communication and communication can sometimes be challenging, not everyone has frequent access to e-mail that we do, but whether that is having weekly conference calls, really communicate with your local organization so you can better get a sense of what they need and how you can best contribute to them and then also spend time for evaluation and feedback when you return, I think people go on a trip and then kind of forget about it, take time to make a presentation to your local organization, give grant rounds, write a paper, really spend time to reflect on your experience and share your experiences with others and I think more needs to be written and shared about global health.

DR. JENNIFER SHU:

One other way to look at starting early is physicians, who start during medical school and residency and just creating an ongoing habit of providing global health care, but for people who are more sees and later in their careers, is it too late to get started in global health?

DR. PARMINDER SUCHDEV:

I don't think so at all, our group at Emory went to Haiti, we had seasoned pediatricians that is one of the reasons I chose not to go I think those of us who do global health work sometimes need to take a step back and allow people who haven't had that experience to travel abroad to have that experience because once you have that experience it becomes somewhat of an addiction and I don’t think it is ever to late and if you are part of a practice where people can help cover your shift, I think it is well worth it.

DR. JENNIFER SHU:

And finally where can our listeners go to get more information about working globally?

DR. PARMINDER SUCHDEV:

There are many resources for global health opportunities. The good place is to start is the Global Health Education Consortium, they have a great website that talks a lot about some of these issues of global health, Health Volunteer Overseas, International Medical Volunteer Association and then just looking at your local university or local organizations and seeing if they have any global health resources are good places to start.

DR. JENNIFER SHU:

I would like to thank our guest, Dr. Parminder Suchdev. We have been discussing the challenges and benefits of international medical volunteerism.

I am Dr. Jennifer Shu. You have been listening to a special segment, Focus on Global Medicine on ReachMD, the Channel for Medical Professionals. Please visit our website at www.reachmd.com, which features on-demand pod casts of our entire library. Thank you for listening.

Thank you for listening to our special series, Focus on Global Medicine as we celebrate this annual holiday season. Everyone at ReachMD wishes you and your family a happy holiday and a successful New Year.

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