When Clifford Gevirtz, MD, was a new attending, he found himself with four weeks of vacation and no idea what to do with it, so he joined the community of global outreach providers by volunteering with Operation Smile. Twenty years later, he’s still volunteering his time and skills abroad.

“In medicine, we’re chasing RVUs [relative value units] and trying to do everything as fast as possible. But the work you do in Third-World and developing countries restores your soul,” said Gevirtz, an anesthesiologist and the medical director of Somnia Inc., in Harrison, N.Y.

Volunteering for a service trip is not without its challenges: hauling resources to places that don’t have them, understanding cultural differences, and accepting the limitations of what can and cannot be accomplished. Ram Roth, MD, a clinical associate professor at Icahn School of Medicine at Mount Sinai, in New York City, tells people volunteering for a service trip that it will be the hardest work they will ever do.

“But it’s also the most rewarded they will ever feel. When it’s completely voluntary and people can’t do anything but thank you, that’s what medicine is about at its core.”

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Why Volunteer for a Service Trip?

Healthcare providers who commit to service trips, also called medical missions, have an opportunity to fix problems like cleft palate, clubfoot, hernia and prolapsed uterus that patients otherwise would live with indefinitely, often miserably. They also provide education and guidance that saves lives. For example, when Roth learned that nurse anesthetists at a teaching hospital in Liberia did not understand why some of their patients died soon after being administered a spinal block in preparation for cesarean delivery, he recognized a knowledge gap that could be quickly remedied.

“In that moment, we realized they didn’t understand the physiological process of a high spinal, when the spinal drifts too high and causes extreme cardiovascular collapse. The corrective action is easy, the administration of epinephrine—not an expensive drug and something they had access to. This moment of education turned out to be lifesaving,” Roth said.

Volunteers can also encourage and educate local providers, and serve as informational lifelines long after they’ve returned to their U.S.-based practices, he said. “We’re there to help them troubleshoot, to answer questions and help solve problems for them.”

Sometimes, the presence of visiting doctors inspires a local would-be doctor to follow their dream. After working with the nurse anesthetists in Liberia, Roth was contacted by one who, noting that Liberia has no physician anesthetists, wanted to purse the education necessary to become one, but lacked the funds to do so.

Through a GoFundMe page, matching contributors and other donors, Roth and others raised enough money to put the young man through a six-year program in Gambia, from which he will graduate in December with plans to return to his home community in Liberia.

“The relationships we build, the changes we get put in place by seeking answers to simple questions, helping with their education—those are the most sustainable parts of doing a service trip,” Roth said.

Before You Go

Decision making around volunteering for a service trip should start with a self-assessment, beginning with whether you yourself are appropriate for such an undertaking. The hours can be long and the conditions can be challenging. “In most of these places, there is no major medical facility. You have to decide if you’re in good enough physical condition. If you’re not ASA I or II, you should really consider whether a service trip is right for you,” Gevirtz said.

Do you have the time? Some organizations, such as Operation Smile, will need you for only about two weeks, but many others, like MÉdicin Sans FrontiÈres, want commitments of at least four weeks to three months.

Do you have the financial resources? Some organizations cover travel, room and board; some cover airfare only; and others request financial input from volunteers ranging from $300 for Operation Smile to $1,200 to $4,000 for International Medical Relief.

Finally, are you prepared to experience situations that may rattle your sense of propriety? For example, in the United States, much medical equipment is single-use, but in low-resource areas items you consider disposable might be rescued and repurposed, Gevirtz said.

“You can’t impose First-World values and ethics on people who have no resources. If we have things left over at the end of a service trip, we give them to the local doctors. If they’re going to reuse it, they’re going to reuse it.”

This conservation extends to rationing care and medicine. “You can use a huge amount of supplies on one patient. After you’ve given someone several liters of fluid and have no more blood available, that’s a real quandary. There are definitely ethical challenges here and not a lot of clear answers,” he added.

What to Bring

Functional clothing (rain poncho, two if it’s monsoon season), nothing that signifies wealth. “Leave the Apple watch at home,” Gevirtz said; he also recommends a money belt.

  1. Copies of your passport photo: one to carry on you or stash in the hotel safe, and a back-up at home that someone can fax to the American embassy if necessary.
  2. If you take medications, bring what you need plus seven days’ worth. Also consider anti-diarrheal, anti-malarial and antibiotic agents, and make sure you are fully vaccinated.
  3. Sleep aids (volunteers often share rooms), multi-tools (a Leatherman can work wonders) and parting gifts (anesthesia reference books are especially well received).
  4. Chargers that can handle up to 220 volts. “It’s really good to have a universal plug and universal transformer when there’s only one outlet in an OR,” Gevirtz said.
  5. An exit plan: This is an expedition, not an adventure. Notify the U.S. Embassy of your presence, make a plan for egress if you have to abort the mission and, if possible, book your trip through a high-end insurance card that includes an insurance policy for medical evacuation.

“If you don’t have a high-end card, it’s worth your while taking out an insurance policy for medical evacuation. They will get you out of a world of hurt very quickly if you are in trouble,” Gevirtz said.

By Monica J. Smith

Gevirtz and Roth reported no relevant financial disclosures. Gevirtz is a member of the Anesthesiology News editorial board.