In my fourth year of general surgery residency, I traveled on a surgical medical mission trip to Guatemala with a recent emeritus surgeon, another surgeon in the midst of his busy surgical practice, and a team of nine others including another surgery resident, nurses, and an engineer. The experience I had was invaluable and exceeded my expectations.
When we arrived on a Sunday afternoon, the hospital was full of patients waiting for a consultation, some of whom traveled several hours to reach us. Our days were full of operating, with repairs of hernias, lipoma and cyst removals, and other routine lumps and bumps, both in children and adults. Virtually all of these operations were done under a pure local anesthetic or a spinal anesthetic with local anesthesia or intravenous sedation to reduce cost, reduce recovery time for discharge, and only possible because of the remarkable tolerance to discomfort!
For the most part, our operative experience was very similar to that of our procedures in the United States; that was, until one of our patients did not wake up from the general anesthesia as expected. The large ventral hernia repair went as planned until extubation, when the patient developed extreme stridor, requiring rapid sequence re-intubation with succinylcholine. We believed that his reactive airway was probably related to chronic environmental exposure to smoke inhalation, as many Guatemalan families cook with wood fire on the floor of their house with the smoke exiting under the rafters of the roof rather than a chimney. Approximately 15 minutes after re-intubation, the patient continued to be paralyzed, but all vital signs were normal. As labs to help confirm the etiology of the patient’s prolonged paralysis were not possible at this hospital, we worked through our differential diagnosis based entirely on the clinical context and examination. At the top of our differential diagnosis was pseudocholinesterase deficiency. The team remained in the operating room with the patient for the four hours it took for him to recover spontaneous respiration, as is typically seen with pseudocholinesterase deficiency. To our relief, the patient was extubated uneventfully. This experience would have been very different in the United States, where we often take for granted the readily available resources.
Surgery trainees from the United States have so much to gain from a medical mission. My patients in Guatemala gave me the opportunity to treat illnesses that I had never seen before, improve my surgical skills, and learn from leaders in the field of surgery. While I will never forget the presentation of pseudocholinesterase deficiency or the surgical techniques I learned, I will also remember our nightly dinners with the local people and interactions with Guatemalan hospital staff While these experiences changed me profoundly as a surgeon just beginning my career, they were also challenging and meaningful in different ways to the other surgeons on the trip in their respective career stages.
For a current practicing surgeon with a busy surgical practice, a medical mission necessitates time away from work and family. The value of the experience comes from knowing that through the sacrifice of your time you are helping patients who would not otherwise receive care and is filled by memorable experiences, like tears of joy shed by a patient and her family as they made the journey for surgery as a celebration of the patient’s quinceñera. These experiences and memories continue to shape your practice (and your soul), and the stories you tell may inspire others to participate in medical missions as well.
For the recent emeritus surgeon with whom I went, time away from family and financial considerations are smaller factors. The real importance of the experience comes from the opportunity to share surgical expertise with surgeons in training and to watch them experience a new aspect of being a surgeon and being a “doctor”. He reminded me of the 6 core competencies of the ACGME: patient care, medical knowledge, systems-based practice, practice-based learning, professionalism, and interpersonal and communication skills. A humanitarian experience may be one of the most educational exposures to ALL of the 6 competencies. Patient care and medical knowledge are easy to support. Systems–based practice was evident when we needed to fix a problem in a setting of low technology and/or materials; practice-based learning occurred when we had to address new problems and learn from our immediate experience; professionalism was practiced within the ethics of a medical system with different social customs, representing the United States and the humanitarian interests in the local people; and especially interpersonal and communication skills when you may not speak the language or fully understand the culture.(1) This setting fosters maturing a surgeon in training to a life of giving, understanding, and professionalism. Even in this late stage in his career, he continues to impact the field of surgery by caring for patients in need and teaching others in various stages of their careers.
Medical mission trips serve both the patients and the providers, no matter the stage of career. While surgery trainees have the most to gain, it can be a life-changing experience for all.
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