Section 2
When I was a fourth year medical student planning to do medical missions, I thought I needed to know how to do everything, especially every surgical procedure known to humankind. I thought, and have since heard many medical students say, “I want to know how to do an appendectomy in case I need to do it.” I actually thought that the best international doctor could do an appendectomy with one hand while doing a Caesarian section with the other hand.
I was not the first medical student to think I needed to be an expert in surgery, obstetrics and family medicine to be an effective medical missionary. One interview at Marshall University International Health Residency went like this:
Experienced International Doctor: “So, you want to do International Medicine?”
Me: “Yes, sir. Very much!”
Experienced Doctor: “I suppose that you think you need to learn Surgery and Obstetrics?”
Me: “Oh yes, sir! I need to know how in case there is no one else around who can do the surgery.”
Experienced Doctor: “Wrong! You should only do Surgery and OB if you like doing them.”
His point was that if you do what you love and feel comfortable with, you will be a better International Doctor. In Ecuador, when the patient needed a Caesarian Section, we called in the surgeon. Since the surgeon was more experienced at cutting and sewing, he took the baby out and sewed the patient back up. He was the best person for the job, and the Family Practice doctors were better at receiving the baby and doing neonatal resuscitation when it was necessary. So the Family Doctor would decide when a C/section was necessary, but the Surgeon would do the work.
In Ecuador, we had surgeons and anesthesiologists. In Malawi, we don’t have surgeons, we don’t have anesthesiologists and we don’t have an operating room. There are other hospitals with all of those within an hour’s drive, both missionary and government hospitals. They have the personnel and equipment to do surgeries properly.
A doctor who is unpracticed in what he’s doing combined with lack of facilities and staff members who don’t know what they are doing is a real recipe for hurting someone. Having a plan in place for what to do if a surgical patient walks in the door is much better than trying a surgery you have not done in years. Of course, in dire emergency, with no other options, trying a surgery may the best option, but exploring all the other options first is vital.
Another issue is that a surgeon is only as good as the anesthesiologist working with him or her. There’s a reason that anesthesiology is a four year residency, there’s a lot to learn. Putting someone to sleep and waking them up again looks easy because anesthesiologists are really good at what they do and they have trained a long time. Anesthesia and surgery are not places for amateurs.
So unless the doctor is cut off from any other resources for many days, knowing where the best available surgeons and anesthesiologists are is far better for the patient than attempting a procedure you have never done. Patients often can be stabilized and moved to a proper facility in about the same time that it takes to find all of the instruments when the doctor and the staff rarely use them.
