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Volunteering abroad adds meaning to medical practice

Physicians practice skills seldom used at home

From the November ACP Hospitalist, copyright © 2011 by the American College of Physicians

By Betsy Friauf

In today's hospitals, test-driven diagnosis and proliferating paperwork often mean more hours behind the computer screen and fewer at the bedside. But that's not the case when a physician volunteers for overseas duty, said several who have donated their time and travel. They are enthusiastic, even elated, about the experience.

“You practice medicine the way we were first taught to do it,” said Robert Barrali, MD, an emergency physician who over the past 18 months has made one trip to Peru and two to Africa as a volunteer with Project C.U.R.E. “You have to use your head and your intuition rather than test-driven medicine. You rely on examination and conversation with the patient. I learned to get along with fewer resources.”

Robert Barrali, MD, examines a patient in Mtinko, ...

Robert Barrali, MD, examines a patient in Mtinko, Tanzania. Photo courtesy of Dr. Barrali.



Project C.U.R.E. (Commission on Urgent Relief & Equipment) aims to build sustainable health care infrastructure in areas that lack it. It sends medical professionals and equipment to more than 120 countries.

On his two-week trips, Dr. Barrali found some similarities to his usual work back home at Mercy Gilbert Medical Center in Gilbert, Ariz. and Chandler Regional Hospital in Chandler, Ariz. “You do things you would do in any busy hospital setting. You see patients in a clinic, go to their bedside, do rounds,” he said. “But you also see things you've never seen before: advanced tuberculosis, 20 different presentations of malaria.”

In Lima, for example, he found simple satisfaction in “rolling up your sleeves and going to work. Doing things you never thought you'd do—dodging stray dogs, playing pharmacist, delivering babies, making house calls.”

Also different is the extent of the need, Dr. Barrali added. “In Lima, 500 people were waiting outside a mission for the American doctors,” he said. “People would travel for up to six hours by foot to see us in Africa.”

Learning and teaching

Another benefit of volunteering, Dr. Barrali said, is the broader cultural experience. “It's exciting to meet the people, learn how they make a living. They have more to teach me than I have to teach them,” he said.

Opportunities to teach are important, however, for Sue Abkowitz, MD, a hospitalist in Newburyport, Mass., who has traveled the world with Health Volunteers Overseas (HVO). HVO is unique because it has a teaching component in addition to medical service, she noted. “In our community hospital here, there is no teaching, so when I go on HVO assignments, I enjoy teaching on ward rounds and in the outpatient clinics and giving lectures. These are things I don't get to do as a hospitalist here.”

Over the last 25 years, Dr. Abkowitz has done five- to seven-week volunteer stints in Indonesia, Bhutan, Vietnam, Tanzania, South Africa and Ethiopia. Her husband is an orthopedic surgeon, and together they have taken their three children with them on month-long HVO assignments to far-flung corners of the world. In each country, her school-age kids attend classes at local schools.

“We were the first with HVO to take along kids—we were the ‘poster family’,” Dr. Abkowitz said. “It's been so good for the whole family—the cultures, school, food, religion.”

Sue Abkowitz, MD (holding X-ray), on rounds with c...

Sue Abkowitz, MD (holding X-ray), on rounds with colleagues in Ethiopia. Photo courtesy of Dr. Abkowitz.



She has also found that volunteering gets her back to medical basics. “About eight years ago I gave up my primary care practice. There was too much paperwork and politics and I was spending hours every evening not seeing patients but dealing with red tape,” she said. “In Africa, it was more like what I went to medical school for.”

In addition to being a part-time hospitalist, Dr. Abkowitz is in charge of the Africa projects for an organization that donates used medical equipment abroad, International Medical Equipment Collaborative. IMEC collects the equipment; repairs, cleans and organizes it into complete medical suites; and ships it in 40-foot containers to clinics and hospitals all over the world. Although IMEC isn't affiliated with HVO, Dr. Abkowitz said her work with HVO helps her understand what kinds of medical equipment are needed in different parts of the world.

“Volunteering abroad is wonderful, but physicians can also volunteer locally at places like IMEC, and still make an impact in another part of the world,” Dr. Abkowitz said.

Getting started

For physicians who are attracted to volunteering overseas, figuring out which organization to use and how to get started can seem daunting at first. A helpful resource is the International Medical Volunteers Association, whose website has an extensive list of organizations that send volunteers overseas. The list provides a snapshot of each organization, including whether the physician's expenses are paid, the organization's religious affiliation (if any), and what types of professionals are needed.

Word of mouth can be another effective method for choosing a program. That's how Dr. Barrali found Project C.U.R.E. One of his patients, a Project C.U.R.E. volunteer, regaled him with a few of her experiences, and “On the spot, I said, ‘Let's go’,” Dr. Barrali recalled.

An important consideration is whether physicians prefer to spend volunteer time in a hospital setting or want a change of pace. Many remote locations have only a clinic, and perhaps a rudimentary one at that.

Most organizations that send doctors overseas handle all the logistics, including locating housing. To find schools for her children, Dr. Abkowitz wrote to doctors who were already volunteering in the countries her family was planning to visit.

Volunteering physicians typically pay their own expenses. When Dr. Barrali worked for two weeks in Peru, it cost him about $2,000, travel included. Tanzania cost a bit over $3,000. But the trips can also include a little vacation. Another doctor who recently returned from volunteering with Project C.U.R.E. in the Lima, Peru, area said he appreciates that a few days are spent “decompressing” before returning to the U.S.

“We spend about one and a half weeks in clinical practice; the rest of the two weeks is sightseeing to adjust from the harsh conditions back to our usual practice,” said Paul E. Scott, MD, of Indian Hills, Colo., a semi-retired physician.

Hospitalists may be uniquely positioned with the flexibility to go abroad for a few weeks or months, according to Dr. Abkowitz. “You can just carve out on the schedule when you will not be available,” she said. In fact, a major factor in her decision to close her primary care practice and become a hospitalist was that she could devote more time to volunteering.

Drs. Abkowitz and Barrali both said they have been feted on occasion like visiting royalty. She has met with ministers of health and even prime ministers. Dr. Barrali said, “We were ambassadors of a sort. In Tanzania there were formalities, we each made a presentation, we sat together to have tea. It's not what I'm used to.”

There are other social rewards, too. “You form lasting relationships with the people on your own team and with the medical staff in the foreign country,” Dr. Scott said.

But the best rewards come from improving patient care. “I've seen patients who had carried incorrect diagnoses for a while, in some cases years,” said Dr. Scott.

Added Dr. Abkowitz, “My payment is the joy of the doctors and nurses, and most of all, the patients.”

Betsy Friauf is a freelance writer in Plano, Texas.

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