I’m going to devote the next several posts to my recent trip to the Philippines. I rarely talk about my other life as a doctor here because this is primarily a kayak blog. Since I mention that I’m an anesthesiologist in the “About Me” section, I think I should take this opportunity to elaborate on that a little bit, so I’ll talk a bit about what it’s like working in an operating room. In addition, I thought I would include some practical information about traveling in the Philippines for anyone interested in going there.
At the end of January 2013 I joined a Canadian medical mission to provide surgical care to indigent patients in the city of Baguio, in the mountains of Northern Luzon. The idea came from a nurse who I used to work with. She knew the mission founder and coordinator, another operating room nurse who works in the same hospital system. The organization is called Greater Outreach/Medical Education Destinations (GO-MED). I want to emphasize that GO-MED is not religious and its constitution explicitly states that the organization “shall remain free of any religious or political affiliation, and shall not engage in the promotion of any religion or any political party.” Although certain individual members may have volunteered for religious reasons, there are also many who are nonreligious and who simply act out of strong humanitarian values.
I volunteered last spring. After a cursory examination of my credentials by the Anesthesia Director I was accepted. I suspect that it doesn’t take a lot for some missions to accept you. After all, you are basically paying a lot of money to take time off of your paying job and go do the same thing you do everyday but in a hospital in a third-world country for no pay. How many people really want to do that? It actually turns out that a lot of medical professionals (doctors, nurses, and surgical technicians) love this kind of work and do it regularly. One nurse I met does two missions a year. Apparently in this business the people with such extensive experience are known as missionistas.
The Baguio mission turned out to be a good choice for a first mission. We set up at Baguio General Hospital, which is a teaching institution. Although Baguio is in the Philippines, it is in the mountains at 5280 ft, so the weather is much cooler than in the lowlands, maybe around 65 to 70 F during the day and down to 55 F at night. The accommodations were wonderful, and the hospital went out of their way to make sure we were comfortable and well fed. It wasn’t like we were living in nipa huts and going for days without showers.
Katya also volunteered to go as the official photographer. The group absolutely loved having a professional photographer around. Not only was she making everyone look really good, but was also posting on the GO-MED Facebook page everyday for all the friends and family back home. The patients signed a consent allowing photography for medical education, staff teaching, and publicity purposes. Some of pictures of them actually ended up on the GO-MED Facebook page. This is actually a big deal because in contrast to the Philippines (and probably everywhere else in the world) America is a highly litigious environment, and healthcare providers are also subject to privacy laws which mandate severe fines for the unauthorized release of Protected Health Information. Because of that, we in America all work in paranoid institutions that are ready at a moment’s notice to fire or discipline any employee perceived to act inappropriately. You wouldn’t even think of trying to post pictures from an operating room on Facebook in the United States, at least not without first consulting an attorney.
An operating room is obviously a privileged area due to issues surrounding patient safety, operational efficiency, and sterility as well as patient privacy. Katya was concerned about passing out at the sight of blood and open bellies, but she actually did fine, at least until she watched me perform a regional block. The sight of a long, thin needle sticking out of my patient’s back somehow made her a little lightheaded and she had to leave the room. Fainting at the sight of a medical procedure or venipuncture is common and hard to predict. It’s typically caused by a reflexive drop in heart rate and blood pressure known as vasovagal syncope. It’s more common in people with “needle phobia”. Ask any anesthesiologist about how many husbands/boyfriends they have seen pass out in a labor room at the sight of placement of a epidural catheter, for instance. The worst cases are the big, tough guys who don’t listen to warnings to sit down when they start to feel funny, but instead insist that they are OK. They go down hard. Among other reasons, that is why nurses will request that the patient’s family clear out of the delivery room as much as possible except for maybe one support person. A lot of people have difficulty understanding that we really don’t do these procedures for the benefit of spectators. It’s hard enough to take care of a labor patient -- we don’t suddenly want to have to call for help to deal with a family member passed out on the floor.
Now for a bit of a rant: I can’t help thinking also that the changes in healthcare we are experiencing at home is driving an interest in practicing medicine abroad. I personally have witnessed healthcare in this county become increasingly consolidated into large regional hospital systems, which are buying up all of the remaining independent physician practices, and which dictate in detail exactly how health care providers will practice. They give lip service to cost-containment while spending millions on unproven, not scientifically validated high technology in attempts to maintain "market share", and demand improved efficiency while burdening providers with ridiculous amounts of “paperwork” (now electronic), and force compliance with complex and draconian rules meant to improve quality indicators. I can tell you that, in contrast to working at home, it was a real pleasure to practice in a hospital that treated me a valuable asset and not a liability (someone who needs to be tightly controlled before he gets out of line) and which allowed me the independence to do the job I was trained to do in the best way I could given the challenge of limited resources. Within a day we set up two operating rooms out of the two dozen cardboard boxes of equipment we brought with us, and on Monday morning we were performing surgery. Despite not having worked together before, the efficiency was way better than I see at home, without sacrificing quality or safety. That says a lot about the teamwork we had, and sadly, also underscores that there are problems plaguing the system I usually work in. When doctors start to prefer working in a third world country for no pay over working in the United States, you know you have a serious problem!
After completing this mission I totally understand why someone would want to do more of them, and even get a little addicted to the lifestyle. It’s a great way to travel the world, meet and work along side locals, connect and travel with like-minded professionals who are a bit on the liberal side, and who are interested in social justice, enjoy teaching, and love practicing medicine enough to do it for free. The local people are extremely grateful for the skills you bring and the work you do. I can't think of a better antidote for professional burnout. You give, but you receive so much more in return. For one thing, you are given affirmation that you are a noble person, which you really are! It is only a toxic culture that has been telling you for most of your life, that you are essentially a selfish, greedy, and “rational” animal, repeatedly, until you believed it yourself.