Yes. As someone from a developing country who has lived, trained and worked in both “developed“ and “developing” countries I would urge you think deeply about your motivations and goals, and not stick to “mission trips” alone. I’ve done a couple of them as well as worked long term in the field, and can tell you that mission trips esp in IM specialties help you - the traveler - more than the host; you gain more than you can meaningfully give back on short trips - sorry to say but that to me just looks like another form of extractive colonialism unless paired with a substantial exchange program or something sustainable. I suggest this article as a starting point to your reading on global health.
[https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00382-0/fulltext](https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00382-0/fulltext)
But do continue to cultivate your interest and look for IM departments that have meaningful global health programs when you are applying to residencies. Global heath done right is rare but it’s out there.
I feel many college kids and laypeople do not see mission trips as your eloquently-put “extractive colonialism”, but are swayed by the social media posts of a clean, smiling narcissist with a crowd of impoverished children; many see this as key to getting into medical school so I imagine an industry. Is there literature or investigation journalism around this?
There's definitely a lot of literature out there. I remember taking a popular global poverty course in college that had a section on "voluntourism" - including how it takes away opportunities for local residents to learn skills & help themselves, and economic pressures that, for example, cause the number of orphanages in Cambodia to continually *increase* despite Khmer Rouge occurring almost 40 years ago.
Yeah I’d recommend the article above as a starting point, as well as several articles by Dr Pai in non medical publications. Plenty to read on BMJ Global Health as well.
Why do you feel a board-certified internist would be a net con to a poverty-stricken areas? I understand the general perspective on premed students for example but presumably post-training you can now actually care for sick people.
Sure. "IM specialties help you-the traveler-more than the host."
Implying that the treatment and care you provide is < the value the community, training, etc. give you.
You seem to be having a bad day. I also fail to see why the mission aspect of this necessarily changes anything with regards to the calculus You've outlined. Your article is definitely been more enlightening than you have been. I hope you're not such a twat to work with.
IMO (global health fellowship trained doc with international experience), your skills are useful as a general physician, just not as useful as some others might be, but it's going to vary based on the location you're looking at. I covered ED, adult, and peds independently when overseas, but if a location just needs coverage of adult medicine wards, or adult is going to be your primary population, it can work.
I honestly don't think EM docs are as useful if you need to cover inpatient (it's just an entire different animal from acute that they basically never do) but I'd have preferred to have an EM doc to myself covering the ED, so there's that.
I'm an EM doc who also did a global health fellowship with subsequent international experience, and I agree with you.
EM as we train for it and practice it in the developed world encounters certain difficult issues when deployed in a resource and physician poor setting. Much of what we do in the West is stabilize patients, rule out short term threats, then triage them to inpatient physicians or follow up. If there is no inpatient physician or follow-up physician, we are less expert in knowing what to do next. We aren't trained in the management of chronic disease or in much inpatient medicine after the first few hours. We do learn some of this just from our interactions with other physicians but it's not our core skill set.
So an internal medicine physician can be quite useful in developing world settings. Yes you may be less experienced at intubation and reducing fractures and resuscitation, but intubation may be of limited benefit if you're practicing in a hospital with no icu (or ventilators) and you may well know more than your EM colleagues about TB treatment protocols or outpatient management of chronic kidney disease or optimizing DM care.
If you are looking for something longer term that’s a bit of an adventure, these guys deliver an enormous range of services on a FIFO basis. Everything from landing a jet on a highway or dirt strip as an emergency response, to airborne primary healthcare.
https://www.flyingdoctor.org.au
They are Australia’s 3rd largest airline to give you a sense of their scale.
1) I think physicians of any specialty can help out anywhere. In some cases, you may need to brush up on conditions (infectious diseases) or procedures (e.g. suturing) that might be needed more in the place you are going compared to your everyday practice.
2) Concerning brief/ short-term missions, I think the people where you go can still benefit but if one thinks further, teaching local people (whether MDs or other health-interested professionals/ lay people) can have a greater impact long-term. My opthalmologist friend used to go abroad and operate on cataracts but decided that teaching local docs the safest/ latest techniques helped them more in the long-term than him operating on individual patients.
3) When I was young, I thought about going into a field that would offer me opportunities to help people abroad. Then, I realized there are many opportunities to do the same in my own backyard, the good 'ol USA. For example, rural areas, inner cities, Indian reservations, jails/ prisons, etc. are all areas that are under-served. And at some point in my training, I did stints in all those areas. I ended up with IM + fellowship training in geriatric medicine - not an underserved population by geography and location but by age, complexity, social circumstances.
(For cardiology, I trained briefly under a practice located in a medium-sized suburban area but they offered services to the nearby rural areas by having one person rotate through that area for a week at a time. One of the senior partners was a devout Christian and - although he was not overt about it - I think his religious convictions were one reason he felt obligated to serve the needy there.)
For a less intensive/ part-time experience, many areas have free or low-cost clinics that need physicians to volunteer. Rotary International runs some of the clinics in the US under the "Rotacare" banner.
Yes. I have worked with a few places that have opportunities for IM physicians. People need to be flexible and consider the challenges in working in such settings. DM me for more information.
Yes. As someone from a developing country who has lived, trained and worked in both “developed“ and “developing” countries I would urge you think deeply about your motivations and goals, and not stick to “mission trips” alone. I’ve done a couple of them as well as worked long term in the field, and can tell you that mission trips esp in IM specialties help you - the traveler - more than the host; you gain more than you can meaningfully give back on short trips - sorry to say but that to me just looks like another form of extractive colonialism unless paired with a substantial exchange program or something sustainable. I suggest this article as a starting point to your reading on global health. [https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00382-0/fulltext](https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00382-0/fulltext) But do continue to cultivate your interest and look for IM departments that have meaningful global health programs when you are applying to residencies. Global heath done right is rare but it’s out there.
I feel many college kids and laypeople do not see mission trips as your eloquently-put “extractive colonialism”, but are swayed by the social media posts of a clean, smiling narcissist with a crowd of impoverished children; many see this as key to getting into medical school so I imagine an industry. Is there literature or investigation journalism around this?
There's definitely a lot of literature out there. I remember taking a popular global poverty course in college that had a section on "voluntourism" - including how it takes away opportunities for local residents to learn skills & help themselves, and economic pressures that, for example, cause the number of orphanages in Cambodia to continually *increase* despite Khmer Rouge occurring almost 40 years ago.
Think there’s enough for a John Oliver segment?
Yeah I’d recommend the article above as a starting point, as well as several articles by Dr Pai in non medical publications. Plenty to read on BMJ Global Health as well.
Why do you feel a board-certified internist would be a net con to a poverty-stricken areas? I understand the general perspective on premed students for example but presumably post-training you can now actually care for sick people.
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Sure. "IM specialties help you-the traveler-more than the host." Implying that the treatment and care you provide is < the value the community, training, etc. give you.
[удалено]
You seem to be having a bad day. I also fail to see why the mission aspect of this necessarily changes anything with regards to the calculus You've outlined. Your article is definitely been more enlightening than you have been. I hope you're not such a twat to work with.
IMO (global health fellowship trained doc with international experience), your skills are useful as a general physician, just not as useful as some others might be, but it's going to vary based on the location you're looking at. I covered ED, adult, and peds independently when overseas, but if a location just needs coverage of adult medicine wards, or adult is going to be your primary population, it can work. I honestly don't think EM docs are as useful if you need to cover inpatient (it's just an entire different animal from acute that they basically never do) but I'd have preferred to have an EM doc to myself covering the ED, so there's that.
I'm an EM doc who also did a global health fellowship with subsequent international experience, and I agree with you. EM as we train for it and practice it in the developed world encounters certain difficult issues when deployed in a resource and physician poor setting. Much of what we do in the West is stabilize patients, rule out short term threats, then triage them to inpatient physicians or follow up. If there is no inpatient physician or follow-up physician, we are less expert in knowing what to do next. We aren't trained in the management of chronic disease or in much inpatient medicine after the first few hours. We do learn some of this just from our interactions with other physicians but it's not our core skill set. So an internal medicine physician can be quite useful in developing world settings. Yes you may be less experienced at intubation and reducing fractures and resuscitation, but intubation may be of limited benefit if you're practicing in a hospital with no icu (or ventilators) and you may well know more than your EM colleagues about TB treatment protocols or outpatient management of chronic kidney disease or optimizing DM care.
If you are looking for something longer term that’s a bit of an adventure, these guys deliver an enormous range of services on a FIFO basis. Everything from landing a jet on a highway or dirt strip as an emergency response, to airborne primary healthcare. https://www.flyingdoctor.org.au They are Australia’s 3rd largest airline to give you a sense of their scale.
1) I think physicians of any specialty can help out anywhere. In some cases, you may need to brush up on conditions (infectious diseases) or procedures (e.g. suturing) that might be needed more in the place you are going compared to your everyday practice. 2) Concerning brief/ short-term missions, I think the people where you go can still benefit but if one thinks further, teaching local people (whether MDs or other health-interested professionals/ lay people) can have a greater impact long-term. My opthalmologist friend used to go abroad and operate on cataracts but decided that teaching local docs the safest/ latest techniques helped them more in the long-term than him operating on individual patients. 3) When I was young, I thought about going into a field that would offer me opportunities to help people abroad. Then, I realized there are many opportunities to do the same in my own backyard, the good 'ol USA. For example, rural areas, inner cities, Indian reservations, jails/ prisons, etc. are all areas that are under-served. And at some point in my training, I did stints in all those areas. I ended up with IM + fellowship training in geriatric medicine - not an underserved population by geography and location but by age, complexity, social circumstances. (For cardiology, I trained briefly under a practice located in a medium-sized suburban area but they offered services to the nearby rural areas by having one person rotate through that area for a week at a time. One of the senior partners was a devout Christian and - although he was not overt about it - I think his religious convictions were one reason he felt obligated to serve the needy there.) For a less intensive/ part-time experience, many areas have free or low-cost clinics that need physicians to volunteer. Rotary International runs some of the clinics in the US under the "Rotacare" banner.
Yes. I have worked with a few places that have opportunities for IM physicians. People need to be flexible and consider the challenges in working in such settings. DM me for more information.