NOTES FROM THE FIELD
All volunteers are asked to submit a trip report to HVO at the end of their assignment. Below are excerpts from recent reports that will give you an overview of their experiences at the sites. All members and donors may access complete trip reports through the HVO KnowNET. If you do not have a log-in and password yet, please click here.
Expectations
"Mwanza was a great experience. In many respects it is like getting in a time machine and discovering anesthesia 30 years ago. I would go there with realistic goals of both yourself and your students. You are not going to train an anesthesiologist in a month, nor change the standards of practice in Tanzania. You can however, get them to have some understanding of what they are doing and why - with that understanding some lives will be saved in the long run. You will also learn more than you can imagine."
Tanzania
"I had no expectations of making significant changes in the anesthesia care at Umtata which is perhaps why I found my time there very gratifying. I enjoyed the more didactic teaching after the morning report as well as the one-on-one in the operating room and felt it was a nice balance. As usual, I learned a great deal from the hospital staff and I also left impressed with how few serious complications they seemed to have (at least according to those I spoke with) with such challenging cases."
South Africa
Reasons to Go
"The professionalism and devotion of Sihanouk Hospital staff is very impressive. Other volunteers from many different nations and backgrounds are such an encouraging sign of hope for humanity. My trip itself might have motivated many people at my workplace. It demonstrated that giving back to humanity is a joyful, elevating experience."
Cambodia
"However, more than tangible resources these local medical facilities are often desperately in need of knowledgeable providers. As individuals, therefore, the greatest resource we can provide is not quantified in dollars but rather conveyed in the form of active education. The concept of HVO is truly noble and I highly recommend this program in Tanzania to anyone who is interested in experiencing international medicine and travel."
Tanzania
"The opportunity to live, work, and teach in China was an amazing experience. The eagerness of my hosts and their residents to learn new ideas and new techniques was refreshing, and the teaching experience was very rewarding. The combination of didactic teaching and hands-on patient care worked well and gave me ample opportunity to share knowledge in an appropriate fashion."
China
Sharing Work Experiences Globally
"I felt that my activities satisfactorily met the needs of the local people, the host institution, and the trainees. I was able to devote as much time to training-related activities as I thought appropriate. I do think the HVO program is having a very positive impact ñ especially to the house staff who were excited to hear about state of the art approaches and different perspectives to patient care."
India
"The experience for me was both richly rewarding and troubling. Rewarding in that I became more complete as an orthopedist through experience and friendships, and troubling to once again see first-hand the disparities between the developed and developing world. I grew to see my role as a medical ambassador for the US, and to help them do what they do. They greatly appreciate those professionals from the developed world care to be there and share knowledge.
Uganda
"The volunteer experience has greatly helped me fulfill the desire and need to contribute internationally. For that, I am indeed, grateful. But I have also become increasingly aware how a narrow focus on acute illness is associated with an expanding population of children with disabilities who will require specialized care. It is apparent that we are doing something important about this at AHC that can provide a model for replication in other low income countries."
"With this in mind, I have taken the opportunity to bring to Africa what I have learned at AHC about routine early developmental evaluation in the medical examination. Following my trip to AHC in 2007 I spoke to the pediatric staff at the Mulago Hospital in Kampala, Uganda. This year I participated in a full day workshop at the University of Kwazulu-Natal, Inkosi Albert Luthuli Central Hospital, Durban, South Africa. In both sites there was considerable interest in the need to focus on early evaluation and intervention of development, and to use a culturally relevant developmental milestone chart. Comparison with the Cambodia experience enabled an understanding and acceptance that could not have occurred otherwise."
"An updated paper on use of such a developmental milestone chart in other underdeveloped areas is to be presented at a symposium on early diagnosis at the World Congress of the International Association for the Scientific Study of Intellectual Deficit (IASSID) in August 2008 in Capetown, South Africa."
Cambodia
"My role was to operate with and teach the local staff. It was interesting to move from my role of learner at home to teacher abroad. I feel that I was able to contribute quite a bit in terms of anatomy, approaches, and technique. I saw my role to be that of a junior consultant on the team. In the morning at conference we would discuss treatment options for various patients that came in the night before. Additionally, I gave several talks on Thursday mornings before the x-ray conference. I feel like the relationship and interaction with the local staff was the best part of the experience from a professional standpoint. Personally, being able to spend time with my wife traveling and working in another country was the highlight of the trip and will be a lifelong memory."
South Africa
"The classes that I did present included an overview of pediatric assessment, pediatric health promotion, the status of advanced practice nursing in the United States, and the role of the pediatric nurse practitioner. I found the faculty and students very knowledgeable about pediatric nursing and eager to learn about the practice of nursing in the USA. I believe my major contribution was working with the pediatric nursing faculty on defining an approach to begin to develop a pediatric nurse practitioner program."
"I believe good progress was made on exploring the development of a PNP program. The core group of pediatric nursing faculty with whom I worked seemed to grasp the magnitude of the task, including the impact on the regulation of nursing practice in India. They assigned ëtasksí to specific individuals and created a broad timeline for completing the tasks."
India
"I rounded with doctors and students every day, which gave me a chance to reinforce concepts taught in lectures. It was more satisfying to me, also, since I was able to learn what happened with difficult patients. We would debate diagnoses and arrive at treatment plans as partners, which worked well. As part of the team, families and patients asked me questions and sought support. I tried to let them know that their Peruvian physicians are very smart, and that I was just fine tuning treatment."
Peru
Housing and Living Environment
"I was housed in the newly renovated Big Bungalow, in a lovely room with air-conditioning, looking out over a beautiful garden. Every morning there was the sound of multitudes of birds in the surrounding trees. This Bungalow is housed on the Christian Medical College (CMC) campus, 7 km from the Hospital."
"The CMC campus is one of a kind with senior faculty accommodated in free standing houses dotted all over the campus. The hospital, which is in the center of town, is easily accessible by bus service (you receive a bus pass) or by auto-rickshaw which is a wonderful way to travel, if you like living on the edge. Auto-rickshaws are very convenient and I used them all the time; however you need to hold on tight because traffic goes in all directions at all times and everyone seems to need to pass the next bike, bus, truck or cow, no matter what side of the road they might be on."
"Meals in the Big Bungalow are an enjoyable event as many healthcare workers from all over the world are accommodated on campus and so there is always a nice atmosphere at these times. The staff is most accommodating and helpful and will attend to any detail to make your stay more enjoyable here. The food served at Big Bungalow (I had breakfast and dinner) was well prepared and tasteful. There is a very nice college campus store which has a good supply of snacks, toiletries, etc which is conveniently located near to the Big Bungalow."
India
Cross-Cultural Experiences
"The nurses tend to be a bit shy until they know if you will be friendly. Each day as I walked up to the nursing education office, I made the rounds (ER, surgical and medical units) greeting everyone, did the same thing before lunch and again on my way in the afternoon when I was through with my lectures for the day. The nurses were glad to see me and explain the conditions of the patients they were caring for. The nurses were always responsive to my questions, although the language/ interpretation of things created some humorous moments."
Cambodia
"I never expected to be touched by so many beautiful people in my time there. In four months I made some special Bhutanese friends that I hope to someday see again and will keep in contact with as best as I can. The people of Bhutan seem to always have time to make your stay easier. They want you to "love Bhutan". However the STUDENTS- all 9 of them- they were undoubtedly the special part of my experience. I still miss their faces each morning. They were so kind, respectful, caring, concerned about my happiness, helpful, appreciative. They made me feel that this experience was totally worthwhile. I can not thank them enough for how good they were to me."
Bhutan
"I did not encounter any difficulties or feel uncomfortable in any situation. There are many outward differences such as food, life-style, and standard of living, but these felt unimportant compared with the rich opportunity to engage with the people."
India
"Cambodians love karaoke as well as Christmas, Elvis and country music. You cannot help but smile while eating a baguette, drinking hot coffee and humming "Frosty the Snowman" at 6:30AM in Phnom Penh!"
Cambodia
Cross-Cultural Communications
I had a difficult time understanding the students my first couple of days and was told they didnít understand me. Our respective accents, in addition to the use of unfamiliar acronyms and drug names, made communication a little difficult during our first week with each other. After the first week, though, I think we had all acclimated and I encountered few problems. They were curious, however, as to why I didnít speak Swahili."
Tanzania
"At times I had to change an example for cultural reasons. For example, I was speaking about anxiety disorders, discussing simple phobias, and gave the example of a fear of spiders. The room erupted in laughter. I asked why and was told they are not afraid of spiders because they eat them.time for a new example Cambodians are afraid of snakes."
Cambodia
First-time Volunteer
"My trip to Moldova was a wonderful way to be introduced to volunteering overseas. I had an opportunity to teach eager students, not only in the OR, but also through patient consultations, and lectures. The country has a fascinating history and free time was spent in visiting museums and traveling to the countryside to see ancient monasteries and vineyards. I do believe that my teaching was beneficial, and will make a difference so that foot surgery will have more recognition than in the past."
"My most memorable experience occurred when I walked into the OR and saw that another procedure was taking place in the same room at the same time as my procedure. At that moment I realized that I was really working in an environment totally different to any that I could imagine."
Moldova
"The pre-departure briefings were comprehensive and helpful. I had an idea of what to expect and had talked with another volunteer prior to my trip. It was still a shock when I actually arrived (my first trip to Asia). Nothing could have prepared me for the emotions and insecurities I experienced during the first couple days of my trip."
Cambodia
Differences in Learning Styles
"I think future volunteers should be aware of some of the differences in the style of education in the Indian medical trainees. It differs from that in the US in that there is much more emphasis on memorization of lists of facts and much less on problem solving skills, etc. I was repeatedly impressed, however, by the breadth of medical factual knowledge that many of these young people have."
"Their ability to solve problems and assemble information was often limited, however, and they often seemed to struggle when faced with medical problems that did not fit one of the memorized patterns. Their educational system seems to often ask "what" but not often "why."
"Those who can do both are very impressive indeed because their factual base far exceeds that of the average US grad (and often exceeded mine). They are forced to rely heavily on bedside skills and are quite skilled as examiners but then seem to give too much weight to fuzzy clinical findings (isolated basal rates for instance)."
India
The Role of the Volunteer
A volunteer needs to be helpful in any way needed. Flexibility, one-on-one patient care with residents, nurses and even interpreters all serve a definite and equally important role. They see, without pressure to change, another, perhaps better way to practice. They learn additional questions to ask, new examination techniques, how to review lab tests, how to assume "case ownership" to avoid delays in care, how to look up on-line articles related to the case. They broaden the diagnostic possibilities. Plus I became their "on-hand-in-the-clinic" resource for consultation...and that's exactly what I did for the two months I was there. Over the past three years of volunteering I continue to be amazed at what the Khmer doctors do with limited resources and, at times, staff shortages and their willingness to make practice changes at their own pace...they have improved in so many ways!
Cambodia
Feedback and objective measures offered evidence of how our presence benefited the patient, patient(s family, and staff. Patients had significant wound closure, appeared to be more comfortable, were positioned in deformity-preventative manners, and were overtly more involved in play, socialization, and education related activities. Families were educated on wound care, and the rationale behind rehabilitative efforts. Staff was trained on new, effective, and cost saving management of wounds, was educated on effective pain management of the pediatric burn patient, was exposed to principles in early excision of burn wounds, and was enlightened on the need for early and continuous rehabilitative intervention for prevention of contractures.
India
Challenges With Teaching
"In the OR I tried to let the senior nurse anesthetists do most of the procedural teaching. They were competent with IVs, intubations and spinals and generally did a good job of demonstrating their skills to the students. Again, it was early in the year, so few of the students had much procedural experience. I used my time in the OR to highlight physiology and pharmacology and relate it to the previous dayís lecture. In the one-on-one setting of the OR, the students were less reluctant to ask questions so I tried to give as much individual teaching as possible. I intentionally did not do any of the cases."
"Each afternoon I would give a 2-hour lecture following the syllabus. However, on a couple of occasions I felt the need to stray from the curriculum. For example, we were reviewing the pre-operative physical exam and I discovered that none of the students had ever heard a cardiac murmur or knew what might cause a murmur. Few of the students could actually name the valves in the heart. Needless to say, there was no point in discussing murmurs if they didnít first know that valves existed. I struggled with feeling that I had to teach them all of anatomy, physiology and pharmacology during my month."
"The other difficulty with the lecture format was that the students had a very wide disparity of knowledge. Some students had no previous knowledge about the nervous system while another student asked very detailed questions about acetylcholine receptors. I tried to lecture to the middle third and catch up with the others after class to either get them caught up or challenge them to stay ahead."
"I had originally planned on giving my lectures in PowerPoint but discovered it didnít allow enough spontaneity. Instead, I prepared handouts that emphasized the key points of each day and provided pictures or diagrams I couldnít reproduce on the chalkboard."
"The last half hour of each lecture was for the students to give their own presentations. I assigned each of them a drug used in the OR and asked them to present mechanisms of action, indications, side effects, etc. It helped them to practice giving talks to their peers and it helped me gauge their understanding of the topic. It also helped me to see how they thought a lecture should be given. I suspected that the Socratic style I was subconsciously using wasnít what they were accustomed to. I tried to change my style throughout the month to reflect what I learned from them."
Tanzania
Practical Teaching Advice
"The changes made by other volunteers are very obvious. The past protocols are in books on the wards and the nurse educators keep all of the lectures and activities. They told me what they had learned and adopted as a result of nurse volunteers. I saw them preparing lectures for nurses in other hospitals using the resources and materials nurse educators had left for them. They had a schedule of lectures that they will be presenting to nurses in other hospitals. The information and handouts left by past volunteers for wound care, EKGís, HIV, diabetes, documentation, neuro, and others were being used while I was there."
Cambodia
"There were several nurses who commented on many of the topics I taught my last trip including safe injection sites in young children and how they continue to use the leg as the injection site for young children. I observed Sr. Naomi and Matron Jolly interacting with families and using some of the information that I taught in various sessions. I believe role modeling and support and respect for the nurses in everything they do and overcome on a daily basis in their work setting is what I tried to provide for the nurses at Mulago Hospital."
Uganda
"One of the three nursing educators, asked me to present lectures on traumatic spinal cord and brain injuries. This hospital does not care for spinal cord patients and few traumatic brain injuries, as trauma patients go to another hospital. Plus, rehabilitation activities are very minimal. I asked Phalla why she wanted me to teach these subjects and her answer was, "we need to learn!" So, I used these lectures as an opportunity to introduce rehabilitation nursing concepts as well as to help the nurses understand how injury affects normal function of the brain and spinal cord."
"I taught 2-3PM & 3-4PM Monday through Thursday, and 9-10PM Tuesday and Wednesday each week. The nursing staff works 12 hour shifts and the night shift was thrilled to have an ex-pat teach them. The hospital security did not have a car and driver available most nights so they sent the ambulance after me! At first that raised some eyebrows at my hotel but soon, the wait staff would tell others, "oh, they are coming to pick up Miss Karen" and more often than not, one of my favorite servers would be standing at the entrance waiting on me as I returned to welcome me "home". Bouncing around an ambulance as we flew through the dark streets of Phnom Penh was a real memory maker.
"The nurse educators decided they wanted me to focus on preparing a variety of self-study modules, particularly when they learned I taught anatomy and physiology and pathophysiology at a local community college. So, I was a self-study production machine! I developed 10 additional self- study modules on various topics from the pathophysiology lectures I already had on my flash drive; plus, I developed a module on the Respiratory System and Suctioning and one on Acute Renal Failure."
"The nurses are required to have 40 hours of continuing education classes annually, which is very impressive. My class size ranged from six nurses to eighteen nurses!"
"After reading former volunteer reports, and in keeping with my normal style of teaching, I brought packages of color pencils, copies of neuroanatomy worksheets (neurons, cross section of spinal cord, and the brain) for the nurses to color and label. I also made six sets of cards (which I brought back with me as my hospital underwrote the laminating cost) with the lobes of the brain, cerebellum and brain stem along with dysfunctions of the brain associated with injury. During the first neuroanatomy class I had the nurses divide into teams and match the cards with the dysfunctions to the correct part of the brain using the laminated cheat sheets that I gave each of them. It took approximately 45 minutes. So, I reduced the number of "dysfunctions" the nurses had to match and we did it approximately three more times. On my last day we had the big TEST. The teams had the six parts of the brain and 12 "dysfunction cards" to correctly match without using their cheat sheets. The team that completed the task first with the most right won a prize. Each person won a bag of candy with a tiny china elephant holding a scented candle. Bonus points were given if the team correctly defined Brocca's aphasia and Wernicke's aphasia. The classes really seemed to enjoy the activities. Much applause and laughter."
Cambodia
Professional Experiences
"I felt that my activities met the needs of the local people, the host institution, and the trainees. I was able to devote as much time to training-related activities as I thought appropriate. I do think the HVO program is having a very positive impact ñ especially to the house staff who was excited to hear about state of the art approaches and different perspectives to patient care."
India
"It is obvious that the presence of the HVO program is effective and needed. While my schedule did not provide for direct observation of the staff with their patients, many therapists commented on the high quality of HVO courses and their desire for the program to continue. The majority of the staff at all three sites was very motivated, appreciative, and has obviously learned many of their advanced clinical skills via HVO volunteers, skills that they would not have access to otherwise."
Peru
"While at Mulago Hospital, I was on the Hematology ward for the full 4 weeks I was at the site. It was definitely a very interesting and educational experience. I was functioning as a SHO (Senior Health Officer) and would be allowed to lead morning rounds with the interns and medical students. I also did one Hematology clinic per week and did 2 calls over the period of one month with a fellow SHO. As a medical resident, it was a great learning experience. I saw a good variety of cases that I would not have seen in Canada. It was a really great exposure to tropical medicine. I also got to learn how to practice medicine in a resource limited environment, which was probably the most challenging thing to learn."
Uganda
"My activities were focused on teaching the 22 nurse anesthesia students, assisting [one of the local doctors] with morning report, and assisting in the OTs. I felt I was able to be effective in meeting these goals and that I had sufficient time to accomplish them. Over the four weeks I became friends with many of the students and even had a little ëgood byeí party with them on my last day. I wanted to treat them to drinks at a local store, but I was surprised to find they had brought gifts for me and my wife to show their gratitude for all my work that month. This helped me to realize how important my role was as an HVO volunteer. Without HVO staff the students are without didactic lectures, handouts, and different perspectives in how to provide safe anesthesia."
Tanzania
"Towards the end of my time there, I found the nurses entering the classroom and greeting me..."Hello Teacher!!"....and when they asked me a question, they said, "Teacher....can you explain...." I don't know why this touched me so much, maybe because my own students at the university do not call me teacher. It just seemed such an honor to have these people see me as their teacher. The sessions began to flow well, they listened to me talk and I drew pictures of the heart and wrote words to explain what is happening in the heart....then we would review practice rhythm strips and I would coach them to interpret the rhythms. One of the nurses asked to have my ECG lectures and practice strips put on the hospital's internet so they can download them and continue to practice. I was honored that they wanted to do this."
"Did my activities meet the needs of the nurse educators and nurses? Yes, because I let them drive what they wanted to learn. Was I able to devote as much time to training-related activities as I thought was appropriate? Yes, by just being available on an informal basis to answer questions as they arose. What I wasnít expecting was not to be utilized as a resource person directly in their clinical areas. They were doing some cleaning and the operating room was closed for a portion of the time I was there, so the clinical area was smaller and less needy."
Cambodia
Being a shoulder specialist, I felt that I had more to offer by lecturing about physical exam, diagnosis, and non-operative treatment options and by demonstrating exams and cortisone injections, than I could demonstrate in surgery in my 2 weeks at the site. My first week was spent with 8 residents who were relieved of their usual duties to spend the week with me. We did nothing but talk about the shoulder -- it was like an intensive boot camp.
When I got there, not one resident knew how to do a cortisone shot in the shoulder, and only two had ever seen a rotator cuff repaired at surgery. Not one had ever seen a shoulder scoped or an open Bankart procedure. We started with the basics of anatomy of the shoulder, then physical exam, then discussed how to diagnose common disorders including impingement, rotator cuff tears, frozen shoulder, osteoarthritis, AC joint problems. I brought some shoulder models which were useful during lectures. We also did hands-on exams of patients and went to the x-ray suite to demonstrate how to take different views of the shoulder and how to interpret them. Then we spent a whole morning injecting patients with subacromial diagnostic/therapeutic lidocaine/cortisone shots. It was incredibly gratifying to see the residents become experts in the shoulder within one week.
Nicaragua
Personal Impact
"This was one of the most memorable experiences of my life. I have waited many years to go to Africa as a physician and to serve in some way. HVO has helped me to fulfill a dream and at the same time I know that the dream is not complete. I want to return and do more to experience the places, the people, the unforgettable moments that will always stay with me. Perhaps I will return to Mwanza, but I think I would like to visit other places including South America, Asia, and other locations in Africa. HVO has helped to instill in me a passion for serving and teaching throughout the world and I am eager to see where I might go next."
Tanzania
"How do I write about an experience that has changed me forever? Going to Mthatha in July 2007 and working at Bedford Hospital was one of the most formative times in my Orthopaedic training on multiple levels. I was one of the last residents to have the extreme privilege of working with Dr. Chris McConnachie ("The Prof") and his wonderful wife, Jenny."
"Overall, this experience has reminded me why I ever became a doctor in the first place. It has fortified my desire to go into orthopaedic trauma and has given me back my passion and focus, which the health care system here in the States can often take away. I will be a lifelong member of HVO and I would like to sincerely thank everyone that has made this possible for me and my family."
South Africa
"This was a more than worthwhile experience, both from the medical experience and the cultural experience. From a medical standpoint, if I have to pick a most memorable moment it was going out on a home visit to see children with HIV/AIDS. These children were managed with anti-retroviral therapy plus supports to maintain nutrition and clean water. The hospital helped build wells for the families, and provides food supplements as well. The most memorable cultural moment was seeing the sun rise directly over the central tower of Angkor Wat at the time of the vernal equinox."
Cambodia
"The opportunity to learn from those who do so much with so little is invaluable. The opportunity to explain orthopaedic principles to those who want to learn is invaluable. The thought that one may make a small difference is invaluable."
Malawi
"Would I do this again? Oh yes, I've already begun my plans to return next year! I would like the opportunity to help with the transference of learning from the classroom to the nursing units, but I will do whatever the educators feel is needed. The nursing management team of this hospital has a clear idea of what they need and they seem to take accurate stock of each volunteer who comes so the hospital nurses receive maximum benefit from the visit."
Cambodia
