NIFA Surgical e-News, December 22, 2014

Have you ever traveled to the ends of the earth to work alongside a surgeon in a MASH-style tent on the edge of a vast desert? If you have, or ever cherished dreams of doing so, you may be a perfect candidate to go on a medical mission with Dr. Glenn Geelhoed, professor of surgery, international medical education, and tropical medicine at George Washington University.

Dr. Geelhoed, a world-renowned surgeon and NIFA-affiliated educator, has been participating on medical missions since 1965, when he traveled to the Dominican Republic just as the island nation was being ravaged by civil war. He has since been on more than 227 trips to more than one hundred countries. His missions serve the poorest people in some of the most remote, underserved areas of the world. As he says, “I am willing to operate on anyone, anywhere, so long as they cannot pay.”

For his tireless work, Dr. Glenn, as he is known by friends and students, has been recognized with numerous awards and honors, including George Magazine’s Humanitarian of the Year and the American College of Surgeons’ International Humanitarian Volunteer. He’s also been nominated three times for a Nobel Peace Prize, most recently in 2011.

Unlike many medical mission groups, where doctors “fly in” and do lots of operations themselves, never to be heard from again, Dr. Glenn’s goal is different. His objective is to indigenize medical care in each of the regions he serves. His goal is to work himself out of a job. The goal for the volunteers who accompany him, then, is not only to care for the patients, but to teach their skills to the local clinicians, whether or not they have ever seen the inside of a traditional schoolroom.

To accomplish this, every RNFA assists other operating surgeons, and the surgeons also change roles for each case, sort of like a round-robin in the operating room. A NIFA volunteer will first-assist on a case with Dr. Glenn, and he or she will also work with a medical student, another volunteer doctor, and the local clinician, who may or may not have had formal medical training.

Dr. Glenn likes to take well-trained RNFAs on these trips, like those certified by NIFA, so they can teach what they know best to the local clinic staff, and he can concentrate on transferring other skills. RNFAs trained by NIFA receive 30 times more surgical skills training during their program curriculum than RNFAs trained elsewhere, and thus bring more to the table; they come in handy in challenging situations like these.

“It’s good to take along RNFAs who already have skills I don’t have to teach, because there are many new skills to learn while abroad – how to do more with less, for example,” Geelhoed says. “I find nurses to be more useful in this, and more adaptable than doctors.”

He tells a story of an ophthalmologist who went with him to Africa, expecting to find an operating microscope with which to do cataract surgery, not even considering that electricity is a rare commodity in areas where care is needed most.

“You can’t bring civilization with you. You can’t be married to tools!” Dr. Glenn says emphatically, adding that medicine and surgery evolved long before microscopes, MRI’s and operating robots did.

In the Sudan and Congo, resources are scarce and infrastructure is nonexistent. You won’t find an operating microscope here, but neither will you find heart attacks or colon cancer. The operations the teams typically carry out include C-sections and hysterectomies, hernia repairs, thyroidectomies, scar contracture releases and cholecystectomies.

These are places where the lights can (and often do) go off at any minute, where tar paper is hung up to protect against bats and other ”creatures flying into the open bellies of the patients.” Dr. Glenn says the key to success for volunteers is to keep your eyes open so you can react and adapt quickly to the circumstances at hand.

Tom Lucero, a fourth-year medical student at the University of Colorado-Denver School of Medicine, accompanied Dr. Glenn on a mission to Malawi and Tanzania last year. Also a Navy-trained diver, he emphasized another important trait in volunteers: the ability to maintain coolness under pressure.

“You have to be able to have five things happening at once, and someone yelling at you, and have someone’s life in your hands, and know how to handle that,” Lucero says.

Being a Navy diver also taught Lucero self-awareness and innovation, which are invaluable traits in settings like the ones he found himself in with Dr. Glenn. Lucero said at times, not just the cases, but the intense onslaught of new sights, smells, and sounds could be overwhelming. So it was very important to have both feet firmly on the ground while being able to think quickly and act nimbly.

The best volunteers have down pat the surgical skills they can teach, along with the capacity to learn how those skills can be applied in different environments, Geelhoed says. Operating in 100+ countries, in 210+ languages with a mask over his face makes non-verbal communication critical.

“The nurses already speak a foreign language – surgery – and I can use that telegraphic communication to emphasize the differences between one environment and the one in which they have already become familiar. There is only one requirement to work with me in these unusual (for them) environments: Semper Gumbi. Always Flexible.”

These “unusual environments” may include tents and open-air settings that look like something from the television show MASH, or even a concrete dorm room where several of the Team Geelhoed doctors may have stolen a few hours of sleep the night before. Dr. Glenn points out that these operating theatres are run entirely on cast-offs—supplies that have been recycled and donated from hospitals back in the U.S.

“I live off the redundancy of the First World, which allows the ludicrousness of discarding perfectly good medical equipment and useful items in the name of liability risk reduction,” he says with a laugh. “That ‘trash’ becomes ‘treasure’ for those who have never had such luxuries to use, let alone waste.”

Jennifer Curran, CRNFA, from Savannah, Georgia, a longtime NIFA educator, traveled with Dr. Glenn to the Philippines and Guatemala, and says the key to succeeding on a medical mission is being open-minded. She says the three medical missions she has been on (one with Dr. Glenn, and two with other organizations) have changed the way she practices.

“I like being out of my comfort zone, where I don’t know their language and they don’t know mine,” Curran says. “Ironically, it helps us communicate more – through touch and eye contact. My interview before surgery is different because of that.”

Whereas before her mission experiences, pre-surgery interviews were often perfunctory and focused on telling the patient about the surgery, today Curran puts the focus on the patient.

“Now it’s more like, ‘Tell me about you’ – and getting them comfortable in their surroundings. I am their advocate, so I get them to tell me about their pain, their worries, their fears,” she says. “And I learn things about that patient that I never would’ve before, because of these trips.”

Several years ago, NIFA agreed to help supply and sponsor many of Dr. Glenn’s first assistants for his upcoming missions. These highly qualified volunteers have worked in places like Sierra Leone, Chad, Ghand, Ecuador, and Philippines. Between 2013 and 2014, NIFA has given over $8000 in donations to Mission to Heal.

“We are so proud to be working with Dr. Glenn Geelhoed. He has done so much to change and heal the world and is single-handedly redefining the goals and outcomes of surgical missions.”

To find out more about Dr. Glenn Geelhoed and his work or to volunteer, visit Mission to Heal.

Jill Ladwig, MSJ, is a freelance writer and communications consultant based in Denver.