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Missions of Mercy Continued.....

Doolittle also sees the value in getting away from the office routine and treats every volunteer experience as a working vacation. Even though volunteers’ days are typically long (and require cooking or laundry in the evening), Doolittle takes advantage of the opportunities away from his first-world grind to enjoy the sights of a foreign country. “I have never enjoyed a vacation more than I have enjoyed going on these trips. There is always so much to see.”

Financial burden also plays a role in decision-making. Newer physicians may owe huge sums of money in loans, so time off to volunteer may compound financial difficulty. Generally, organizations do not cover the travel and insurance costs associated with short-term volunteering, although some, like DOW, will. Volunteers typically do not receive any sort of stipend to help defray living expenses, although many organizations try to foot the bill for longer-term volunteers (six or more months). The good news? The cost of travel is usually tax-deductible, although the value of the actual service usually is not.

That’s why pre-planning becomes important. Strauss, of Mercy Ships, has designed his volunteer experiences with such success and conviction that he has transitioned into a full-time volunteer. After selling his ophthalmology practice he has realized his dream of offering his skills as a gift to those who are less fortunate. “We had been preparing for a long time for this transition and I enjoy serving in this way,” he says.

Sustainable opportunities

Nearly all returned physician volunteers feel that the experience of volunteering in developing countries pays them back in dividends—the feel-good kind rather than the financial. “Even though I feel we do something good for the people in the countries we visit, you learn at least as much from them as they learn from you,” says Lena Dohlman, a Boston-based physician, who has volunteered on several occasions for Health Volunteers Overseas. “Every volunteer I have ever talked to has repeated that.”

On the best days, volunteering can provide some of the most exciting professional moments of one’s career. On the worst, being in an entirely new environment, devoid of the comforts of home and in a new and different culture, can challenge the most veteran volunteers. When Ramona Sunderwirth, MD, a New York-based emergency medicine pediatrician, first started volunteering with Doctors of the World (DOW) in the early 1990s, she was sent to Brazil, where she had grown up.

“I was initially supposed to be stationed in a small city in the north of Brazil, but when I got there, the team on site had received a radio call that there had been a fire in some Amazonian villages, so instead they flew me there. The nurse who was there said we had to go into the villages to see what was happening,” she says. “We walked two or three hours through the jungle. As it turned out, there had just been some inter-tribal fighting.

“That was my beginning. I stayed there three weeks, and it was quite a challenge, but it got me excited about continuing that kind of work.”

Since then, Sunderwirth has gone to the south of Mexico during the Chiapas unrest of the 1990s, Rwanda during the reintegration of the Hutus from refugee camps, Iraq, Macedonia during the Kosovo wars, and most recently, Nepal during the peak of the Maoist conflict.

Reputable organizations, even those like DOW, which places volunteers in conflict-ridden settings, carefully evaluate and monitor safety and will not operate in areas it deems “high risk” for personal injury or harm. DOW provides volunteers with insurance, including emergency medical evacuation while they are in-country, and volunteers are connected with local institutions that have been in the area for some time, so there are personnel to help ensure volunteers’ safety as well.

Safety aside, Sunderwirth’s personal volunteering philosophy meshes well with that of DOW.

“We try to highlight the connection between human rights and health outcomes, focusing mainly on populations that are excluded for one reason or another,” she says. “We try to identify the political, social, and economic exclusions, and how that impacts health. When there is a conflict, those populations become most vulnerable, most in need.” So the organization works to take populations from extreme vulnerability and insecurity to be more stable, in ways that are lasting.

This notion of doing work that is sustainable by local health-care providers after volunteers leave is a common concern among many physicians and the organizations through which they work. Health Volunteers Overseas, for example, works to identify needs of countries (at the request of teaching institutions or ministries of health), then develops clinical education programs to meet these needs. “What we’re trying to do is share information and techniques, so they can provide better care with the resources available,” says Kelly, the HVO director. “Our volunteers will get hands-on, but the idea is that you’re showing someone how to do something.”

Another example of an organization that works to educate local providers is the International Center for Equal Healthcare Access (ICEHA). “Our focus is never on providing direct patient care, but rather on making sure local providers have the knowledge they need,” says Katie Graves-Abe, the director of operations for the organization. “We want to leave people in these settings in charge of their own healthcare, particularly in regards to HIV.”

The infectious disease specialist and a professor of medicine at the University of Arizona in Tucson, Steve Klotz, MD, is a volunteer for ICEHA. He feels passionately that his efforts to improve the healthcare situation of the impoverished overseas are sustainable.

“When I first started volunteering, many universities had programs in Africa, which were staffed mainly by Americans who volunteered briefly, then left. American medications were too expensive, not sustainable, and disappeared when the volunteers disappeared,” he says. “This is not an adequate response to the problems in the Third World. This will not solve the country’s problems.” Klotz says a better response is programs that are involved in mentoring local practitioners rather than simply distributing medication.

Organizational issues

Making the decision to go and finding a suitable project may seem like the most difficult parts, but it is also necessary for potential volunteers to consider carefully which organization would best complement their own strengths and needs. When trying to make a decision, there are a number of considerations to keep in mind.

First, there are two main types of volunteer positions for physicians: teaching and mentoring positions or practice positions. “They’re really very different,” Dohlman says. “In a teaching position, you pretty much work by yourself, not as a team. You really get integrated into various departments. You spend a lot of time with your contact person in the hospital. I feel that’s a better way to get to know people and feel part of the country and culture for a short while.” The ICEHA is an example of this type of organization. The ICEHA’s philosophy is to mentor and build programs for the long term rather than just to heal.

In a practice position, conversely, physicians volunteer for periods of varying length and employ their skills to care directly for those in the greatest medical need. A strength of this approach is that pressing health concerns, especially in post-conflict or humanitarian situations, are addressed immediately and with a very capable effort. An important caveat when deciding whether to volunteer with a practice-based organization, however, is to make sure that the work it does is sustainable. Research organizations with an eye to whether more emphasis is put on the actual volunteering or the sightseeing opportunities available in the destination country. There are organizations that tout their programs as “life-changing,” but it could be that the most “life-changing” event is a tourist experience.

Doolittle, who has volunteered for about two weeks every other year for the past 10 years, advises that less-experienced volunteers avoid the smaller and less established organizations. He has seen many well-intentioned but naïve volunteers fail in their first attempt. “There are a lot of people who just wander down to Brazil, try to set up a program, and are unable to make anything good come of it,” he says.

Fell says another consideration to keep in mind is whether the organization is religiously affiliated. “Most faith-based organizations are extraordinarily tolerant of those who are not active or deeply involved in faith,” he says, “but there are exceptions.” A long-time volunteer, Fell says some organizations require their volunteers to sign a letter regarding their faith. “I have never been discriminated against because of my faith, but I am tremendously careful.”

There are just as many varieties of organizations as there are types of volunteers. The expected length of service can vary, from a short-term stint to a long-term experience, to an entire lifetime of service. There are small organizations that offer one-on-one experiences for the volunteer and massive organizations that treat thousands of patients at once. Some organizations offer general health care to all in emergency and humanitarian situations, while others perform only extremely specific surgeries on a tiny sector of the population, such as cleft palate surgeries. There are organizations that work only in prevention or only in treatment, only in mentoring or only in practice. Some operate from the secure confines of a floating hospital, such as Mercy Ships, and others work entirely within a foreign country. A physician has many options when selecting a volunteer experience, and all of these factors should be weighed before making a final decision. A potential volunteer can take comfort, however, in knowing that an opportunity surely exists that meets both the needs of whatever population he or she wishes to reach and the skills the physician possesses.

Although the number of decisions to make and range of choices may seem staggering at first, repeat volunteers assure the process is worth it.

“Volunteer! Do it without fail, if you possibly can,” Klotz says. “One of the real benefits is that you feel better. Each time I have gone, I come back feeling better.” g

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Lori Herring is a free-lance writer, graduate student, and public health program coordinator in Birmingham, Alabama. Tyson Volkmann works in the field of public health in emergency preparedness. The Olympia, Washington, resident is also a would-be travel writer