What Should I Specialize In to be a Medical Missionary

What Should I Specialize In?

I used to think that the only useful specialties for the medical missionary were Family Medicine and General Surgery. My ideas have broadened a bit since I have had some real experience on the mission field.
One area I never thought of was Anesthesiology. Without an Anesthesiologist the surgeon is extremely limited in what he or she can do. They are limited to minor procedures or trying to put the patient to sleep, and more importantly, wake her up again, all alone. Additionally, since the anesthesiologist put people on ventilators all the time, she is the doctor best prepared to manage patients on a ventilator in the Intensive Care Unit. One or two patients in the Intensive Care Unit can keep an anesthesiologist without a good night’s sleep for a week.
In general, the broader the training, the better one is prepared to be a missionary physician. The three most useful specialties in my mind are Family Medicine, General Surgery and Anesthesiology. In my opinion, combined Internal Medicine/ Pediatrics is a close fourth, followed by Internal Medicine or Pediatrics alone. In Shell, until we had a Pediatrician who cared for hospital patients, the Family Practice doctors were caring for sick Newborns. All we had to work with was two weeks of NICU training in residency and the Harriet Lane Handbook. We were practicing way over our heads, but most of our patients did alright because the handbooks were well written and God was gracious.
There is a role for specialists and sub specialists, but that’s mostly in teaching in short term stints in the large medical centers in a country. The Christian Medical and Dental Associations and medical schools regularly have groups that go to developing countries to teach local specialists at the big medical centers. The specialists will teach new procedures or do an update on information to the national specialists.
Another place for specialists in developing countries is on one to two week medical brigades. Long term missionaries able to treat most anything that walks through the door, which means a generalist who is able to find information or know where to send a patient is best equipped to greet the patient at the door. The problem is than when a specialist is needed, one specific specialist is needed for one patient right now, not in four months when the brigade is coming.
In Ecuador every year a group of Ear, Nose and Throat surgeons from Operation Hope would come for a two week intensive caravan to repair cleft lips, cleft palates and ears that never grew. They did a lot of great work, but they were US doctors fifty weeks a year and US doctors who worked overseas two weeks a year. They would take an entire crew of surgeons, anesthesiologists, nurses, translators and helpers. The only part of third world medicine these doctors experienced was the beds the patients used post-operatively. I was always grateful to Operation Hope, but I also knew they would be gone for fifty weeks once they left.
I took a group of children from the jungle to the Operation Hope Brigade every year. I would translate for the doctors and bring them my patients. The surgeons would teach me about what they were doing, what criteria they would use to make their decisions and how they would do their miraculous surgeries, and let me bring my patients to the front of the line. The more they taught me, the more I could prescreen patients for them and make their time more efficient. They did a great work but they weren’t International Doctors in the way I want to be, but my patients and I were very grateful for their work.

What I Thought I Needed to Know to be an International Doctor, and What I Really Needed to Know

Section 1
What can we learn from one doctor’s experience? The most important thing to learn is that one experience is not everyone’s experience. I have had a pediatrician colleague who had to do a Caesarian Section because he was the most qualified person available at his hospital in Gabon, Africa and it needed to be done. I have also heard of overseas physicians who put the patient to sleep themselves, then operated while every few minutes stepping to the other side of the curtain to ask the patient how she was doing. Thankfully, I have never had to reach that far to care for a patient.
Many doctors have a variety of experiences. Few have to be the Lone Ranger who can do everything by themselves, but most have to adjust to the medical environment and medical personnel as they are. When I was a medical student, I thought I needed to know how to do a lot of things all by myself. What I really needed to know was how to learn while making decisions, how to adjust to changing situations and medicine stocks, how to work with professionals of various cultures and education levels, all while having the final responsibility as “captain of the ship”.
I have been a missionary doctor for seven years, five in Shell, Ecuador on the edge of the Amazon rainforest, and two in Lilongwe, Malawi, a tiny country in southeastern Africa. While I was a resident, I spent two months in a mission hospital in Washim, India. Each experience taught me more about what a missionary doctor really does and who a missionary doctor really is.