NIFA Surgical e-News, December 21, 2012

An instructor from Stanford University Medical Center recently contacted Dr. Geelhoed with questions about medical missions, and Dr. Glenn referred him to NIFA. The instructor asked,

“In your opinion, what are the top 10 knowledge sets and/or skills you expect a student to have when they arrive to participate on an international medical or surgical mission?”

We asked some NIFA students who have gone on various medical missions and received the following tips via email:

From Christian (Virginia)

Top 10 List when Traveling with Dr. Geelhoed

1. Be prepared to be camping the whole trip. May not happen but be ready. Meals are local or freeze-dried stuff from REI. You will often sleep on a camping mat. You will use an outhouse or hole in the ground. You will bathe in a bucket and wash cloth or maybe even a bathtub. You will not have Internet for extended times and anything that needs charging will run out somewhere on the trip. Even if this does not happen, be mentally prepared for it to happen.

2. It’s not your operating room at home. Ours had bats flying through it as we were operating on wood tables. Your petzl headlight is your OR light.

3. Understand principles, not just tasks. In these remote places, you need to know how to sterilize instruments by boiling them, reuse needles, know what suture is absorbable and which are not. How to create a sterile field on a table and patient.

4. Learn how to conserve your supplies for your cases. What’s reusable and what’s disposable.

5. Know the McBurney and Shouldice hernia repairs.

6. Know thyroidectomy techniques.

7. Basic medicines like antibiotics, valium ketamine for the OR.

8. Be prepared to see clinic patients, i.e., history, physica,l differential diagnosis. Have a good resource on hand.

9. Hydrocelectomy procedures.

10. Just enjoy the ride. Dr. Geelhoed is very good at these sort of trips

From Jody (Colorado)

I am a NIFA graduate and have almost 20 years of experience in the operating room. I have also been actively involved with 2 groups completing surgical mission work. I have traveled to both Honduras and Nicaragua on these missions. I have been involved with both teaching local surgeons to provide laparoscopic procedures as well as providing services unavailable in needy communities such as plastics, urology, and extensive general surgery.

1 – In my opinion, the single most important thing anyone needs to know prior to going on a surgical mission is sterile technique. You are often in untoward conditions that make adhering to sterile practices more difficult (such as old fashioned sterilization techniques and facilities not equipped like we are accustomed to here). When you go into an area to provide surgical services to the needy, the last thing you want to do is leave them with an infection. Often, there won’t be anyone there to deal with it when your team leaves, and you could be leaving them with a deadly problem festering.

2 – Foreign language is important but usually most groups arrange for an interpreter. I have never found this to be a problem, other than I feel like I miss out on a lot of “the experience” because I don’t always understand what the patients are trying to tell me (usually they are trying to express gratitude).

3 – The third thing I can think of is knowledge of common problems specific to certain areas, things we often do not see here in the U.S; at least to the degree you see it in older patients in third world countries. There is so much early intervention here, we often do not see cleft palates, goiter, or huge hernias that have not had intervention.

From Bruce (Michigan)

I was able to travel with Dr. Glenn Geelhoed for the month of June to Central African Republic. The knowledge I gained during my time there was incredible. Dr. Glenn was the most incredible source of knowledge you could ever imagine. With the amount of trips he has made to the Area of Inaccessibility he understands the disease processes there and has written some great books on the findings there.

The things that I found to be very beneficial to the work we did was my 30 years of OR experience. Anatomy and the running of an OR Suite are very important. If you are going to be working at the OR table, it is very important to know how to obtain hemostasis without the use of eletro-cautery. Clamping and tying of vessels and tissue was the most important thing I was able to do while assisting the two African surgeons we worked with while in CAR. The tying techniques taught by the NIFA program helped me to achieve the confidence and skills needed to be an integral part of the team. You need to know the layers of tissue you are closing and where your strength layers are to keep the wound from dehiscence. You also need to know the types of suture materials that are used and what type you should use for each layer. You will find that the doctors will trust your students to close with little to no supervision and they must know what is the best for each layer. They will also need to know what types of needles are swaged on the end of their suture and why you would use them in each circumstance. We did many operations while we were there, but our main ones were hysterectomy, thyroidectomy, and hernias.