Stories from the Field
It was by random chance I got to work with the GFR team in Jordan 2014. Turned out the organization they were working with in Jordan needed an extra translator, and I just so happened to be in Amman at the time.
In November of 2014, I found myself, very spontaneously, on a mission trip to Ethiopia. I have no medical experience, nor have I ever been on a mission trip, or even left the United States. I had always been moved to help others, and gravitated towards experiences that allow me to learn about other cultures. So when the opportunity presented itself, to be the photographer for a medical mission trip, leaving in 3 weeks; I did all that I could to find myself there.
I was on a bus from DC to NYC to arrange for an art show about my home (Syria) when I thought: what if I could do more? What if I can use art to do more than raise awareness about what’s going on at home! That’s when I thought of “Blooming Syria” a simple project where I work with Syrian kids to plant garden in the shape of the Syrian map. From that point on, the ideas were flowing and the end result was my project “Seen for Syria” which combined art education/ therapy with gardening and exchanging letters and drawings between Syrian refugee children and children in the U.S.
On May 29th 2014, I arrived to Amman, Jordan to start my 10-week long project with SCM and little did I know that by joining two medical missions as a humanitarian, my whole perspective on the Syrian crisis will change: I expected to see children that are depressed, and had lost all child-like qualities because of what they’ve been though. To my great surprise, these kids had a lot more to offer that I thought: while we offered them toys and candy and did face painting and planted vegetables, they offered all of us, especially me a lesson in survival; a lesson in the true meaning of hope. They shared the sincerest and heart-breaking stories about their lives in Syria, the people they had lost and what they hope to happen.
Many kids asked me to be their teacher. They’d give me hugs and kisses and shook hands with me. Not for a second did I feel that I was helping. The whole time I was at any camp, I felt that I was being showered with love. The kids I had worked with during the medical missions and at the SCM center had proven true what Vincent Van Gogh said two hundred years ago: “There’s no art like loving other people”. Today I have more hope than ever that we will have our beautiful Syria one plant at a time and one hug at a time, and like a phoenix, my beautiful Syria will rise from the ashes.
Here at the JAHJAHfoundation we wanted to do a little more than Mission Trips. We wanted to empower the individuals we met. Through Emergency Ultrasound we teach physicians in developing countries how to use the Ultrasound machine to make a difference in the lives of the patients they meet. We share ideas with our Jamaican Partners with honesty and integrity .
Mission trips have always been something I wanted to do…but a medical mission trip?? Never thought I would have the chance to be a part of something so amazing – as a non-medical person. When my son and his colleagues were gearing up for their first trip to Haiti soon after the earthquake, I was just pleased to offer support in the form of our garage for the storage/staging area for the supplies they had gathered. Supporting their energy and passion for this trip was enough for me, I thought. But the idea kept surfacing: What if there was a place on one of the teams for a non-medical person? Would there be something for me to do? Would I just be in the way? Did I have skills that might be useful?
I told my son that if there was ever a place on a team for a non-medical person who was willing to do whatever was asked…I would love to go. Never thought that would happen. Then the word came that there was room on a team for me. I had no second thoughts, no reservations – I was going! Didn’t know what I would do, but knew that I could do something that would help.
My first trip to Bernard Mevs Trauma Hospital in Port-au-Prince showed me that my skills as a retired teacher and administrator could be used in this setting. I organized a shipping container full of donated medical supplies, helped inventory the pharmacy shipping container and organize the contents, kicked a soccer ball with a peds patient who desperately needed diversion, fed a hydrocephalic peds patient who had an NG tube, held a beautiful preemie girl until she died so that the time of death could be noted and she could have human contact – the list goes on. When needed, I took specimens to the lab, prescriptions to the pharmacy – and returned later to pick these up, etc. There WAS a way for a non-medical person to be useful and needed.
When I didn’t have a specific task to do, I interacted with patients and their families, learned more about the various services that the hospital provides, and tried to be a support for the medical team members (often something as simple as getting Coca Cola from outside the gates via the guards).
My second trip to the same facility was perhaps more productive, since I knew what to expect, and the staff knew that I wanted things to do! They were more prepared for me as a non-medical person; and had several tasks lined up ahead of time, such as defrosting the ER refrigerator. When I wasn’t occupied with a task, I learned so much from watching the volunteer medical team, the Haitian staff, and the incredible Haitian patients and families.
Every mission location is different, and not all locations would need or welcome non-medical personnel. I do hope that more locations will be open to this, since there is always something for everyone to do. I also hope that non-medical personnel will consider these kinds of trips, and have confidence that they can make a contribution no matter what their age, training or background.
My experiences in Haiti have made me eager for more opportunities to serve. I look forward to my next trip – wherever it might be.
Mission trips as a non-medical volunteer …. Think you don’t have a skill set that can help on a mission trip? You are wrong! Just because you are not a health provider does not mean you have nothing to offer on mission trips! There is much more than just seeing and treating patients on these trips. Health education, triage, pharmacy, and social services are all aspects which you may find yourself doing. There is no way the mission work can proceed without these services! Often volunteers may find themselves helping out in villages as well aiding in community development. Home repairs, building homes, aiding in agricultural practices, and helping out in community planning are more examples of tasks which a volunteer may find themselves involved in on these trips. Bottom line: everyone has something to offer on these trips, and your help is definitely needed!
Health education in the field
This is a very important topic that I believe is often overlooked on many mission trips! While it’s wonderful to go spend a week doing clinic work, the reality of these mission trips is that it’s a short-term mission trip, and when the week or so is over, clinic ends! While your group may have treated many during the week, the week has ended. This is why health education on these trips is of vital importance. Education topics could include basic hygiene, diet, exercise education, and diabetes education. These are all topics that can be easily taught and can go far in helping keep a community healthy. For medical providers, teaching the local nurses and med students is a great idea! This can include lessons on medications, imaging such as Ultrasound, IV starts, line placements, etc. Be vigilant and prepared, and bring some prepared classes to the field for the community you will be working in!
Flexibility, Adaptability, Patience and Enthusiasm
All of the above traits are very important on relief trips! I believe that each warrants a word when it comes to relief work.
Flexibility – Be very flexible with your expectations. Despite a given itinerary, on some trips the plan changes as soon as you land. Timelines often fall apart and days may run very late with earlier mornings then expected. Transportation may not always be on time, and this may change plans. Keep in mind you are often working in an unfamiliar environment. Expect the unexpected.
Patience – Be patient and expect delays, long days and nights, and communication barriers.
Adaptability – I cannot stress this enough. Be prepared to work outside your normal work skills and parameters. For example, this might mean you doing wound care rounding on medical patients or seeing pediatric patients when you are an adult internist. For a nurse, this may mean working with adults despite being a pediatric nurse. Be a team player, and don’t complain about duties assigned to you. Often everyone is working a bit out of their norm when it comes to relief work. Work as a team and assist in anyway you can when out in the field.
Enthusiasm – Get excited about your trip and show it in the field. Get plenty of rest prior to your trip, for you may be working long hours. However, proper rest at night can sometimes be difficult depending on the environment you are working in.
My first medical mission trip: In the following pages I will talk about my experiences on my first trip to Haiti following the devastating earthquake in January 2010.
The biggest “first” is it was my first medical trip outside the United States. I had done disaster relief for Hurricane Katrina, but when the Earthquake in Haiti happened in January of 2010, I was given the opportunity to go and help with the disaster relief efforts. I remember it all happened very quickly. A friend and co-worker had gone on a medical mission to Haiti in late 2009, and were asked by the organization she went with, if she could come down and help. She said yes, but didn’t want to travel alone, so she asked if I would go. I said yes before checking with work, or family to see if it was possible. In the next week we made our arrangements, got our shots, packed our bags, and collected supplies from local hospitals. As the scope of the disaster was becoming apparent to the world, it was obvious that more people would be needed. Within a few days twelve local doctors, nurses, and medics were selected and we all rushed to get ready. Our team arrived on the twelfth day after the quake. Most of us had never been to a third world country, done medical care outside the U.S., or spoke Creole, the native language of Haiti. None of us had been exposed to a disaster of this magnitude, and that made all of us nervous about what we would find and do. We left St. Louis, MO with snow flurries and nine degree temps. Four hours later we stepped off of the jet onto the tarmac of a small airport in Northern Haiti with high temps (90 degrees) and high humidity. We were driven about 10 miles away and due to the horrible road conditions it took over 45 minutes. As we pulled into the compound of the organization we were working for, we were met by a nurse from the U.S. who said “put your stuff on the porch, get your scrubs on, and go to work”. Our orientation consisted of a briefing as we walked up the street to the hospital. Once we got there the O.R. team went one way, and the E.R. team the other. We barely saw each other the rest of the week. The most powerful image I have in my head to this day is the stack of medical waste and body parts outside the O.R. suites that needed to be hauled off and burned. The conservative estimate is 300,000 died in the quake that hit Port-au-Prince, Haiti. Thousands were injured, and millions were displaced and homeless. The hospital we were staffing was the receiving point for the U.S. Navy and international agencies that were evacuating injured out of PaP (Port-au-Prince). We would receive anywhere from 30-50 patients a day by helicopter, or pick-up truck. The hospital we were at was a 70 bed hospital with very limited capabilities. In the space of several days the school across the street became the new hospital. The basketball court became the receiving area. We triaged and began treatments here. Pts. were then moved to one of sixteen classrooms and treated there. These rooms had no power or lighting, our patient count was so high that the benches had to be removed so we could make more space on the floor. We shared translators between rooms; we did patient care after 4 pm by headlamp, and were responsible for finding our supplies in the boxes of completely random materials arriving from the states. As American medical workers we were freaked out at the lack of equipment, trained staff, supplies, documentation, etc. You name it, and it didn’t resemble what we knew. So we set out to create order, as much for us, as for a smoother flow to patient care. We moved patients so men, women, and children weren’t in the same room. We cohorted ortho, trauma, wound care, and contagious patients together. There were entire rooms of patients identified by their injuries i.e. pelvic fracture patients, or the Ex-fixes, or the amputations. We worked around the clock to set ourselves up for success, and to make the learning curve shorter for those who followed us. By first world standards the care we gave was horrible. We as providers were constantly asking for things we would use normally and were being told that those things don’t exist in Haiti. We spent our entire time behind the curve, and by that I mean many of our patients who had BKA’s for example had to go back and become AKA’s due to infection and no antibiotic therapy after their initial care. One of the most frustrating things for me that week was losing patients there that we would never have lost here. A little girl with pneumonia died for a lack of oxygen and a peep valve, or a man became septic and died because he never spoke up and told anyone he felt worse. We are so used to patients screaming and yelling as their pain got worse, not so in Haiti… the patient that was quiet, sweating, and clicking their teeth were the ones in the worst shape. We had to quickly learn that this culture and their ways were different than our own. A phrase I began using, and still use when introducing new folks to medical mission work is “Looking at third world problems through first world eyes”. We cannot make the same moral, ethical, and medical decisions there that we can here. Once you learn that, then you begin to work within the confines of the hospital or area that you are in.
When I was asked to write this about my first time, I was flooded with memories and feelings. Most of which I don’t have time to go into. I will share that when I came home the first time I was messed up. In my job as a Flight Medic here in the states, I see the worst of the worst, but only one or two at a time. In Haiti I saw no end to the patients, and felt like I wasn’t doing any good. At one point my first week our e.r. staffing ratio was 92:1. Can you even imagine that?! We worked 20 hr days, in tropical conditions, with little food or water. My departure for home was as abrupt as my orientation was at the beginning of the week. We literally got yanked from the hospital and put in the truck that the new folks were getting out of. Our hand-off was “umm, the hospital is there, the patients are there, there, there, and over there…supplies are there…good luck!” So six hours after I was knee-deep in patients, I was home alone. I slept for 24 hrs, and when I woke up I hurt. I had more physical pain throughout my entire body than I have ever had. I had not even to begun to process what I had seen and felt. The PTSD manifested itself for me in crying for no particular reason. It wasn’t that I was thinking about it, talking about it, seeing news reports, or anything I could put my finger on. I am enough of an emotional control freak due to the work I do here, that it pissed me off I couldn’t control the trigger for my emotions. I can honestly say that once I let the tears come, I began to heal. The best thing for me personally, was going right back a week later. When I left I felt like we were abandoning these people, there was so much work and care to be done. Going back I got to continue my work, I got to see patients I had cared for getting better, and while I didn’t slow down, I could see things beginning to get better. Since my first trip I have made nine more. I will continue to return to Haiti, even as I begin to go other places in the world to help. I still don’t speak much Creole, but I now have friends and coworkers there that I keep in touch with. I have bonded with one little boy and have helped him and his family. Watching him grow and succeed has been one of my greatest joys. I now help out in a trauma hospital in PaP. This facility sees the worst of the worst in Haiti, and is very well suited for my job and skill set. Everyone who goes will get something different from the experience. All I ask is that you try. It may or may not be for you, but I can promise you that you will be forever changed by sharing your heart and talents with the underserved in a third world country. You will be humbled, will look at your own life and work differently, and that kind of infection is good for us all.
Imaging in the Field- ULTRASOUND
1. If you are lucky enough on a field mission to have an ultrasound handy, you will find this of great use. The portable models are lightweight and easy to pack. Ultrasound can be used for a number of things including abdominal scans, pelvic scans, fetal ultrasounds as well as cardiac and chest scans. No matter what setting whether it be hospital or field, ultrasound can be very useful. Included in this section in the future will be ultrasound courses designed for the field physician. Standby!
Pharmacy in the FIELD!!
This is a very important aspect of field trips. Often times you may be fortunate and have a pharmacist come along on the trip. A couple of pre-trip rules I have learned when it comes to this aspect of the operation…
1. Have someone in charge of pharmacy well before the trip. This person should be responsible for generating a master list of what medications are being brought on the trip. The list should be updated weekly and distributed to the entire team. Often different group members can bring different meds, and if there is an identified shortage on one, this can be addressed.
2. Keep in mind that just about any medication is needed. You will be surprised how much tylenol and motrin can help in certain areas. If you have any excess meds lying around that are not expired, bring them. Someone out there could benefit from them, I promise!
3. If you are looking for places to donate meds, there are plenty of places that may be willing as long as you present it in an organized and effective way. Show them a pamphlet or brochure identifying your mission and express your passion for your mission. Walmart, local pharmacies like Walgreens, etc. might be willing to help. We recently received a $200 donation from Walmart by simply showing them a mission brochure. If they do donate, bring them back a photo showing your work in the field. This is a great way of saying thank you. (You may want them to contribute again on another one of your missions!)
4. There are organizations/agencies that can help supply you with meds for these types of relief trips. I will soon be providing this list in a section on the site.
5. You can never bring too much of any medication…better more than less in the field!
6. Commonly used and most distributed meds: motrin, tylenol, cimetidine, multivitamins, meclizine, raglan, antidiarrheals, lotrimin, diflucan, albendazole, mebendazole, prednisone, albuterol, anti-hypertensives, flail, amoxicillin, cipro, kefex, ancef, acyclovir, aspirin, metformin…just to name a few off the top of my head!
7. Make sure and clarify with your trip coordinator what type of meds to bring to the field, for example, IV meds vs. oral meds only.
IV meds and fluids can take up a little more space and weigh more than oral meds. Make sure you will be allowed and able to use IV meds in the field…otherwise they may go to waste and cost you more money to fly over.
8. Make a final check of the master pharmacy list prior to departure. Identify med shortages and make one last ditch effort to collect what you can! Make sure the physicians, PA, and NPs all have a master list prior to leaving. Too many times I have not had a list, and items I could have found before leaving home did not get supplied for the trip!
9. Be prepared to show these meds when arriving at Customs. Have a master list, smile a lot, and tell them what you are there to do.They usually won’t make a big issue of this, but it has occurred before.
Field operations and Pharmacy!!
Day 1 of clinic operations…BE PREPARED FOR CHAOS! This always seems to be the case of relief operations that require a setup. If you are in a hospital or town clinic then you need not worry about this. Setting up pharmacy can be quite tedious as all the meds need to be distributed in small packets written in the native language CLEARLY AND SIMPLY!! This can take hours to do, and you will often find yourself working late into the night after clinic days to reorganize the pharmacy for the next day. It’s a work-in-progress indeed!
1. Rule number one – Have one person in charge, not several.
2. Don’t forget to bring many small plastic packets and a felt tip marker for writing instructions on meds.
3. When a patient approaches to pick up a medication, take your time with them. Do not rush things and just give them the medication. Assume, rightfully so, that they do NOT understand how to take the meds. Explain precisely how to take the medication. Otherwise, you may have them taking an antibiotic the wrong way and taking the pen med every 4 hours. I cannot stress this enough!! WAY TOO OFTEN, PATIENTS LEAVE THE PHARMACY CONFUSED!! Have them go through the instructions verbally with you after you explain them to them!
4. Help the pharmacy with cleanup at the end of the day. They are often the last part of clinic to break down at days end and will be working late into the night to reorganize.
5. If you have the supplies and there is a high incidence of parasite, DEWORM everyone. Also, give vitamins to everyone as well… iron supplements along with b12 and folate are good options as well.
6. If you have the supply to do so, give everyone a small supply of motrin and tylenol. Everyone has aches and pains from time to time that could benefit from one or both of these.
7. You may find out that by the end of the trip, you are short of needed meds. Try and keep this in mind all week so the folks you see on the last day don’t end up shorthanded. Unfortunately, this occurs all too often.
8. Prior to the end of the trip, make arrangements to leave any extra medications with a organization that can get them to the right people.
SAFE TRAVELS ABROAD
Mission work abroad can be very exciting and rewarding…truly an adventure you will remember the rest of your life. There are multiple ways to assure your safety on such missions. Here are a few I’ve learned along the way.
Prior to your trip:
1. Do some research on not only the agency you will be working with but also the country you will be working in as well. I’ve provided links to all of this information as you will see. The state department website is a wonderful resource and provides up to date travel advisories for all countries across the globe.
2. Register yourself with the state dept. smart traveler program. This program lets the state dept. know when and where you will be and gives them contact information in case of an emergency.
3. Get travelers medical insurance! Too many times, I have seen people injured while doing mission work abroad. Treatment overseas can be very costly as well as the cost of transportation home after the injury if serious enough to require a medevac. I’ve provided a section on this alone and listed multiple providers for this type of insurance. On the bright side, it’s really not that costly and it’s definitely worth the cost.
4. Make multiple copies of all your agency’s information and your locations and leave a copy with your spouse or family.
While in country:
1. ALWAYS TRAVEL WITH A BUDDY OR A GROUP!! In the Marine Corps, we called this the buddy system. You are responsible for your buddy, he or she for you. You travel together and return together.
2. Keep your passport on your person at all times. I recommend a money belt.
3. Try and keep the trip coordinator in the loop as to your whereabouts in case you and your buddy turn up missing.
4. In some countries, the agency you are working with may prohibit you from traveling on your own. This is the case for the work I did with Medicare, and it is for very good reason. Understand and respect these rules set forth as most times they are put in place for very good reason.
Translators in the Field:
Providing aid in many countries will require translators. Often your group is fortunate to have one or several individuals who speak the native dialect. This is a definite plus.
A couple points to be aware of with the use of translators:
You may notice, as I often have, when using translators during relief work, that dialogue between translator and patient is lengthy and you feel you are missing some vital information which is not translated to you. Don’t get frustrated even though its easy to be sometimes. The translators will often say that much of the chatter with the patient was not important even though you may feel it is important. My recommendations:
1. Let the translator know if you feel you are missing something, and ask the question again until you get the type of answer you want.
2. HAVE PATIENCE!!!!!! HAVE PATIENCE!!! It’s easy to get a bit frustrated at times with translation services especially when there are large numbers of patients to be seen. But keep in mind that you are there to serve and help, and these translators are there to do the same.
3. Don’t get rushed!! It’s easy to do if you have a large number of patients. Take your time especially when using translators and addressing the pertinent issues on your exam with the patient.
4. Most translators are usually paid by the agencies you will be working with, but in some cases, they may not be, and you might be expected to leave a tip or give payment.
If you are like me, it’s often hard to spend a week or two away from the gym. What’s gained is lost quickly, and it’s so nice to keep a weekly routine. I’ve gotten around this by doing a few morning exercises to keep the muscles toned and adrenaline pumping. Often it’s fun to incorporate the rest of the team in morning exercises. While in Kenya, my colleague and I often did morning calisthenics to a little music. This kept the muscles toned and helped get the blood flowing in the morning. Pretty amazing to workout in such a beautiful setting as the Kenyan countryside. No matter where you are serving, a bit of daily exercise goes a long way. Feel free to share your experiences with this subject!! 🙂
12 Feb 2010
My first mission trip – Relief work in Haiti
Upon hearing of the devastation and high casualty rate in Haiti after the earthquake, one simple thought came to mind!! I have to get down there!! I have the ability to help and there is no reason I should not or cannot get there! This is my duty, my moral obligation…….. I thought, I will get there at any cost……. and I did and what I experienced forever changed me…….
Due to the logistical complications of getting into Port Au Prince after the earthquake, I was able to book a trip into Cap Haitian and from there catch a two hour ride to Milot for work at a rather nice community hospital called Sacre Cour…… I was to be working with an organiztion called the Crudem Foundation… This organization was well established in the community and had partnered up with the hospital and community years back providing volunteers and helping run the hospital….. Upon arrival, it was obvious the hospital had been taking in large numbers of refugees from Port Au Prince daily and was in great need of help in order to handle this influx of patients…….
I arrived in early afternoon and what I saw simply caught me short of breath…. I arrived to literally find a MASH type unit set up with four tents of 40 + patients with ailments ranging from crush injuries to burns to gross gangrene. The staff already in place looked overwhelmed and a bit haggard but hard at work and focused on the tasks at hand… I was shuffled into the volunteer quarters made up of an outdoor shack with numerous tents scattered about….. Orientation was brief and it was obvious everyone was working out of their element….. I was assigned tent four which was made up of 47 patients many with severe crush injuries and a few severe burns…. One physician was signed to each tent along with two nurses and a tech. There was no turnover of patients between staff as the doctor in charge of the tent prior had left the day before…….
After a brief orientation to operations, our week began….. My first three patients included a young 17 year old boy with a comminuted femur fracture who had lost his entire family in the quake, the second a older 47 year old gentleman who had bilateral femur fractures and severe burns to his face and scalp, the third was a 23 year old with multiple thoracic and lumbar fractures…… and thus the list went on with similar type injuries…. I was immediately impressed by the courage and strength of these patients…..no matter their injury or their loss, they always smiled when I approached their bedside and seemed so thankful for the attention brought to them…. I immediately felt attached to them and over the next few days came to care very deeply for all of them…… One thing was very clear as well, this is the type of work I was born to do and it was from this point on that I made a promise to myself that I would do so…….
As the week went on, we volunteers serving together became very close….. We became a team despite having little experience in this sort of work…… Not only did we come together, but the community of Milot as well as the patients, all came together in our relief efforts!! Patients helping care for other patients…. The 17 year old boy I served with often joined me on my rounds and helped me greatly in addressing the large amount of wound care needs of the patients in my tent….
Despite long days and nights, I awakened every morning with an energy and true sense of purpose that carried me through the day……. By the end of the week, I was ready to do more!! Sadly though, duty called back home and I left Haiti along with most of the rest of the team, as a new round of volunteers came in to replace us…..
After reflecting back on such a week, I realized that the wonderful team and courageous patients I had met, had given me something so unexpected —- the realization that service to others is the greatest purpose of man!! I’ve taken seven more trips to Haiti since then with other trips to Honduras, Kenya, Peru and Brazil and I still feel the same!
Communications are obviously a key component in planning a trip and coordinating logistics. Depending on the country, there may be several options available. Several aspects of communication are discussed here to help you along.
Cell phones – Cellular phone technology is usually an option in most countries, but varies depending on your type of carrier. To check and see if your carrier has coverage in the area you are operating in, or if they have a contract with another carrier in the area for coverage, simply give them a call. There may be an international plan available from your carrier if you do many of these trips. Be sure and make note of the rates with these plans as they can be a bit expensive. Data roaming fees can be very pricey so be sure you shut this option off on your phone as soon as you arrive in country unless you have a very good plan. Ask me sometime about the $900 dollar fee at@t leveraged on me for having my data roaming on for five minutes while in Peru…not a fun thing to deal with!!!
Satellite phones – These are always an option and provide coverage no matter what location you are in. There are numerous sites you can go to to either buy or rent a satellite phone.
Local area disposable phones – Another option available is to buy or rent a temporary phone with a local carrier while in country. Often this is simply accomplished by asking the agency you are traveling with how this can be done. This is a good way to save money if your home carrier will not suffice.
Walkie talkies – These are always good to have on hand to allow for easy communication while on ground with your team or group. Available for purchase online or at most chain stores like Walmart or Target.