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Pre-trip thoughts

Posted by Lisa Ryujin, MD (a fourth year Ob/Gyn resident from Kaiser Permanente Oakland in preparation for a global health elective in Daet, Philippines with Bay Area Surgical Mission).

There are so many reasons that residents are interested in participating in global health projects. I have wanted to be a part of the development of clinics, medical education and self sustainability of medical facilities that are coming into their own. I have also been interested in the way medicine is practiced around the world, the different expectations that patients have of their physicians, and how we can better deliver quality health care. I have always learned much more than I have taught, and it has given me insight to different parts of the world. Up until this trip to the Philippines, I have focused on facility and medical personnel development, and much less with patient care.

In the past I have been hesitant to go on a surgical ‘mission.’ I thought that most places, even rural places, have physicians that provide wonderful medical care, and by going in and doing surgeries in places where there were local surgeons, we would undermine their skills. I also believe, that as a surgeon, you are responsible for surgical complications, and with short surgical missions, we are unable to deal with the possible complications of our surgeries. During past (Vietnam and Kenya) medical trips, I have never declined to participate in a surgery when the local surgeons have requested assistance, but when I did participate, it was clear how key communication during surgery is. In Vietnam, the names of the surgical instruments were in French, so even when I asked for standard instruments, the scrub would look at me bewildered. We take so many things for granted in our operating rooms, our wonderful anesthesiologists and CRNAs, our circulators and nurses and EVS make our jobs run smoothly.

At the last Global Health Educational Consortium, in Montreal, there was a session on the ethics of surgical care abroad. I attended, as I was interested to see the latest updates, papers and innovations. The West African College of Surgeons made a plea for more surgical missions. They said that in the major cities, there was a large concentration of surgeons, but in the rural areas, there may be facilities, but no doctors to staff the operating rooms. A Rwandan surgeon stood up and reported that after the 1995 genocide in Rwanda, there were a total of 5 surgeons and 2 anesthesiologists left in the country, today, there are still only 30 surgeons and 12 anesthesiologist to serve a population of 11 million.

Organizations like BASM (Bay Area Surgical Mission) are able to provide free surgical procedures in a place where all surgeries are a fee for service. And organizations like Doctors without Borders and Relief International, are able to offer surgical services to places in crisis. This is a wonderful temporary solution while simultaneously working on medical education, community development and self sustainability.

I am grateful to be able to go on my first trip, solely dedicated to providing surgical care, with people from BASM. A team that I have worked with every day at Kaiser Permanente in Oakland, a team that I love and trust, it will be a fantastic (and exhausting) opportunity to focus on patient care together. I am so happy to have talked with these surgeons from Rwanda, who had expanded my understanding of needs in other countries.

We fly out tomorrow for a 3 day journey to our final destination in Daet, Philippines. More to come!

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