The Pros and Cons of Overseas Missions

Truly laudable efforts can have some downside.

By Mitchell Brinks, MD

We've all heard about these humanitarian missions, whether from ophthalmologist colleagues recounting their adventures, at non-profit booths at Academy meetings, or perhaps we've considered a trip of our own.

The world's vision problems are enormous. The World Health Organization and others report millions with poor vision overseas. Or perhaps on a more personal level, when we travel in developing countries, the widespread cataract and pterygia don't escape our well-trained eyes. We may notice a young girl tasked with leading her grandmother around the village instead of going to school, or perhaps a young boy suffering from keratitis.

We often find ourselves wishing we could help some of these people. These problems speak very deeply to us as ophthalmologists. We have years of specialty training and are able to resolve many of the eye problems that plague people in the developing world. So, what, if anything, should we do about it?

Dr. Brinks attends to postop cataract surgery patients while on a mission to the Pacific island of Ebeye in Micronesia for Canvasback Medical Missions.

The Typical Mission

The most popular answer is the short-term “mission trip.” This type of humanitarian effort fits well into US practice schedules, allowing ophthalmologists to pitch in overseas, yet return home in the same length of time as a typical vacation. In lieu of a standard vacation, we venture to a foreign land, perhaps down a bumpy jungle road or up a remote river.

When we arrive, we will find enough people with white cataract or raging pterygium to keep us busy for the duration or our trip. We might find a clinic and OR that are fully functional, or perhaps we are asked to work in essentially primitive conditions capable of inducing a hypertensive crisis in our office manager back home. We wade in and do our best, sometimes transforming lives, sometimes dealing with devastating challenges.

So how do we weigh the pros and cons of the increasingly popular mission trip? How do they impact the practicalities and intangible factors that keep our staff, patients, and ourselves working together? Let's do a thorough evaluation of each of the key factors that impact on missions.

Inspiration and Morale

PRO: Mission trips appeal to many physicians' fundamental motivation: caring for others. While healing remains the basis of our profession in the United States, the day-to-day challenges are often dominated by pushing papers, computer keystrokes and numerous management head - aches. These distractions from healing patients can leave us longing for that pure ideal that drew us into medicine in the first place.

Mission trips bypass paperwork to heal patients. We can find the opportunity to focus entirely on our patients and the experience of taking care of them. One chance to “dip into the well” of our deeper inspirations can rejuvenate our enthusiasm for our career in a way unreachable by any amount of regular vacations, exercise programs or practice restructurings.

Ophthalmologists find themselves at the top of the food chain of medical specialties in terms of reward vs. time spent in the field. We provide the single most effective skill in any field of international healthcare: the ability to completely and permanently restore sight with a short and safe surgery. The immediate and tangible evidence in brightly smiling patients at one-day postops is unrivaled.

CON: Missions trips often demand a lot, right when part of us might be wishing for a relaxing vacation. They can be taxing and stressful, both personally and professionally. Doctors and nurse teams are often cobbled together from a variety of clinics and operating theaters, meaning a fair amount of learning and compromising will be necessary for a productive trip. Just changing one aspect of an operating theater environment, much less all of them, along with team members, adds at least some measure of stress to any surgeon's routine. Some trips will ask that you deal with older equipment. Medicines that are not well-suited to the patient (or even expired) can make mission doctors feel uncertain about the care they provide. Mission doctors also don't have anything to offer some patients with very serious eye problems, an often draining experience, especially in contrast with patients' often high expectations of a “team from America.”

Taking some time out for sightseeing, our author, Dr. Brinks (right), does some bicycling on the Pacific island of Ebeye.

Challenges to Surgical and Diagnostic Skills

PRO: We've spent many years learning and honing our skills. The mission field will regularly challenge what you thought you were capable of, with often surprisingly good results. A dominant principle guides many decisions in the field: that if you don't operate, no one else will. Thus, ophthalmologists take on challenging cases that may demand skills they haven't used for years, or perhaps only read about. Where in the US they might hesitate to proceed, a great many physicians gain confidence and abilities that eluded them in their home practice.

CON: Surgical challenges in these settings can be daunting. Surgical techniques difficult enough on one's home turf may be extra challenging in a foreign setting. There often is no backup if things go wrong, no vitrectomy unit or helpful local colleague in a time of need. Wrapping one's thinking around the reality that even a number of complications may still be best for the patient population at large is a difficult shift from the precise guidelines that direct much of our work at home.

Expanding Horizons

PRO: Few standard vacations offer the development of relationships that rival the depth and intensity of those formed on overseas mission trips. The whole community you'll work in will see you as much more than just another tourist traveling through, perhaps bringing you into their homes or sharing with you some of the local secret getaways. As a reward for the real change you'll make in their lives, you'll share are a bond, and gestures of gratitude, as sincere as can be found anywhere else in your life.

CONS: Mission trips and their organizers often face unpredictable hazards. Unreliable transportation and public utilities can prevent teams from reaching their destination or producing results on par with the investments made to get them to there. Other hazards can be more serious. In some countries, unclean water and food can be unavoidable, even by the most professional and careful supporting organization. Crime or local political conflict present their own hazards, limiting participants' chances for recreation after hours or the ability to travel outside of the organized mission team itinerary.

Practice Morale

PRO: Instead of hitting another golf course with your colleagues or staff, you're standing side by side while facing one of the world's great burdens. The capability of facing these challenges is the noble reward of your combined many years of training and service. However, the central tenet of our professional lives — that you are a highly skilled healer — can easily fade into the background during your practice and among those you rub shoulders with in the day-to-day grind.

When we have busy days ahead, we naturally respond by becoming focused and pragmatic, presuming our professionalism and principles will support our actions with a minimum of hesitation. In truth, these underlying principles of integrity, commitment, professionalism and compassion for our patients are the foundation of everything that happens in our practices. Reinvigorating these principles can solve myriad frustrations, loss of motivation and loss of enjoyment of work, which often present the most perplexing, and poisonous, problems an ophthalmology practice can face.

CON: Practice burdens can be heavy, and leaving for an extra two weeks to work overseas when there are more than enough patients wanting to access the practice can chafe inter-professional relationships. Some staff may be more suitable for these trips and selecting among them, or perhaps excluding them from an exciting adventure, can be yet another source of tension in a busy practice environment. Some partner unconvinced of the merits of these trips may even question your commitment to your domestic practice if your presence and interest in overseas work continues to grow.

Community Stature

PRO: Our patients and our communities are increasingly aware of the plight of people overseas. While business and financial challenges continue to push into the practice of medicine, here is an opportunity to remind all of us of the noble principles that distinguish our profession and our behavior.

Dr. Brinks performs an eye exam on a surgical candidate while on a mission to the Pacific island of Ebeye in Micronesia.

The unassailable gesture of physicians and their staff providing care for those who need it most can transform the clinic and OR atmosphere.

Says Joyce Arend, former administrator of the multi-site Oregon Eye Specialists group, “The trips are always really energizing for our practices, especially if staff members go along. They always bring back great stories and great pictures, which we use for marketing — in our waiting room, on the Web site and newsletter. The patients really think it's great. I can't think of anything bad about them. They're even easy to schedule as they can fit within the usual vacation schedules.”

The benefits of doctor-patient rapport can be dramatic, from work enjoyment, positive and cooperative attitude, to lessening risk of malpractice suits and increased staff morale. Building rapport in the usual daily practice is central to all aspects of practice development, but a huge boost can be a key reward when returning home from a mission trip.

CON: Members of your local community may feel the unmet need for healthcare here at home. Some may question the need to travel overseas to provide care to needy people, while some struggle with healthcare costs here in the US. Economic arguments support overseas work, if done well, but the concern is important. Some organizations address this concern by providing care both domestically and internationally. One advantage of staying home and pursuing these goals is the ability to stay with family and avoid long plane flights to foreign countries. As well, leaving your practice is always somewhat disrupting.

How I Got Involved

I first went international during a medical school elective, working at the famed Behrhorst Clinic in Guatemala and running my own clinic in a former guerilla territory in the central highlands. I went straight to the territory of American Samoa following residency, spending three years in the island chain developing their eyecare system.

After four years of private practice in Hawaii, I returned to Oregon to earn an MPH in international health. Recently, I conducted research and developed a clinic and surgical center in East Timor, and now spend the majority of my time in Cambodia and Samoa developing ophthalmology training programs and public health projects.

A few of the great programs to consider include Canvasback Medical Missions, a very highly regarded and effective organization with 18 years of experience in the Pacific islands — a region with few dangers from civil conflict, crime, or infectious disease, yet with plenty of need for eye care.

Medical Teams International also has an excellent track record around the world, leading trips throughout the year and in response to catastrophes and on regularly scheduled mission trips.

Surgical Eye Expeditions has been a stalwart and key figure handling innumerable missions, with expertise in providing a wide array of medical equipment and consumables.

Pros Outweigh Cons

Weighing all the pros and cons I have described here, I do believe that every US ophthalmologist should consider going on one or more overseas missions at some point in his or her career. As an ophthalmologist, you have the skills to do a great deal of good in a short period of time. Whatever the hardships encountered, I can assure you that each trip you undertake will be personally rewarding and produce a lifetime of fond memories. OM

Dr. Brinks has ophthalmology practices in John Day and Burns, Ore., as well as IIwaco, Wash. Internationally, Dr. Brinks directs the activities of Ohana Eyes International, a non-profit currently dedicated to building sustainable eyecare systems in Samoa and Cambodia. Dr. Brinks can be reached via e-mail at brinksm@yahoo.com.